Which type of splint is recommended for a nondisplaced comminuted fracture of the radial head and neck?

Management of Nondisplaced Comminuted Fracture of the Radial Head and Neck

For a nondisplaced comminuted fracture of the radial head and neck, a posterior splint (back-slab) is the recommended immobilization method as it provides better pain relief compared to collar and cuff immobilization. 1

Assessment and Classification

• Nondisplaced radial head fractures are typically stable fractures without significant displacement or angulation 2
• Careful evaluation of joint congruity and stability is essential to determine optimal treatment approach 3
• Radiographic assessment is the primary diagnostic tool to confirm fracture pattern and displacement 1

Treatment Recommendations

• For nondisplaced comminuted radial head fractures, non-operative management with immobilization is appropriate 4, 5
• Posterior splint (back-slab) immobilization is preferred over collar and cuff for better pain control in the first 2 weeks after injury 1
• Immobilization should be maintained for approximately 3 weeks with radiographic follow-up to confirm adequate healing 6

Evidence Supporting Posterior Splint

• Randomized controlled trials have demonstrated that posterior splints provide superior pain relief compared to collar and cuff immobilization within the first 2 weeks of injury 1
• A prospective double-cohort study with 40 patients (20 in each group) showed better pain relief with back-slab immobilization compared to collar and cuff 1
• An RCT with 50 patients (27 randomized to posterior slab, 23 to collar and cuff) confirmed better pain control with posterior splinting 1

Rehabilitation Protocol

• Active finger motion exercises should be initiated early to prevent stiffness, which is one of the most functionally disabling complications 3, 6
• Early mobilization following the immobilization period is important to restore function and prevent joint stiffness 4, 2
• Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 6

When to Consider Surgical Management

• Surgery is generally not indicated for nondisplaced radial head fractures 5
• Consider surgical intervention only if:
  • Displacement becomes >2-3mm 5
  • There is mechanical block to pronation/supination 5
  • Associated elbow instability or ligamentous injury is present 4, 7
  • Fracture involves more than 3 fragments with significant comminution 7

Potential Complications

• Immobilization-related complications occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy 3, 6
• Joint stiffness is a common complication that can be minimized with appropriate early motion exercises 3
• Monitor for signs of displacement during follow-up, as this may necessitate change in treatment approach 2

Special Considerations

• The radial head is an important secondary stabilizer of the elbow; therefore, maintaining its integrity is crucial for elbow stability 5
• Associated injuries should be carefully ruled out, as comminuted radial head fractures are often associated with ligamentous injuries 5
• In elderly patients with osteoporotic bone, more careful monitoring may be required during the healing process 1