What is the initial treatment approach for a nondisplaced comminuted fracture of the radial head and neck?

Treatment of Nondisplaced Comminuted Fracture of Radial Head and Neck

The initial treatment approach for a nondisplaced comminuted fracture of the radial head and neck should be conservative management with immobilization using a removable splint for approximately 3-4 weeks, followed by gradual mobilization. 1, 2

Assessment and Classification

• Radial head fractures are the most common elbow fractures, accounting for approximately 5% of all fractures in adults 3
• Nondisplaced fractures typically occur in isolation and can be treated nonsurgically 1
• Careful evaluation for associated injuries is essential as radial head fractures may be complicated by ligamentous injuries or other elbow fractures 1, 3

Conservative Management Protocol

• For nondisplaced comminuted fractures, initial treatment consists of:
  • Immobilization with a removable splint 4
  • Duration of immobilization typically 3-4 weeks 5
  • Active finger motion exercises should begin immediately after diagnosis to prevent stiffness 4
  • Radiographic follow-up at approximately 3 weeks to confirm adequate healing 4, 5

Rehabilitation Considerations

• Early active finger motion is recommended to prevent stiffness, which is one of the most functionally disabling adverse effects of fractures 4
• Finger motion does not adversely affect adequately stabilized fractures in terms of reduction or healing 4
• Early wrist motion is not routinely necessary following stable fracture management 4

When to Consider Surgical Management

• Surgical intervention should be considered if:
  • Displacement exceeds 3mm 5, 6
  • Angulation/tilting exceeds 10-20 degrees 7, 3
  • Intra-articular involvement with step-off 6
  • Active elbow movement is not achieved within 3 weeks 7
  • Instability of the elbow joint is present 8

Surgical Options

• For comminuted fractures requiring surgery:
  • Open reduction and internal fixation (ORIF) may be considered for fractures with three or fewer fragments 8
  • Prosthetic replacement is recommended if stable reconstruction is impossible 1
  • Resection should be avoided in the acute setting but may be considered within the first 5 weeks post-injury if necessary 7

Potential Complications

• Immobilization-related adverse events occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy 5
• Without proper treatment, complications may include:
  • Joint stiffness 4, 5
  • Secondary displacement 1
  • Radial head necrosis 1
  • Nonunion 1
  • Instability of the elbow joint 8

Follow-up Protocol

• Initial radiographic evaluation to confirm diagnosis and fracture pattern 5
• Follow-up radiograph at approximately 3 weeks to assess healing 4, 5
• Final radiographic evaluation at the time of immobilization removal to confirm adequate healing 5
• Monitor for restoration of range of motion and function 3