What is the treatment for a radial neck fracture?

Treatment of Radial Neck Fractures

For radial neck fractures, treatment should be based on the degree of displacement: fractures with <30 degrees of angulation require only immobilization, while more severely displaced fractures require closed reduction followed by percutaneous pinning if needed, reserving open reduction as a last resort due to inferior outcomes.

Treatment Algorithm Based on Fracture Severity

Minimally Displaced Fractures (<30 degrees angulation)

• Immobilization alone is sufficient for fractures with <30 degrees of angulation and minimal translation, particularly in younger children 1
• Use removable splints as an appropriate immobilization option 2
• Obtain radiographic follow-up at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 2, 3

Moderately to Severely Displaced Fractures (>30 degrees angulation)

The treatment hierarchy should follow this sequence:

1. Closed manipulation first - Attempt closed reduction under anesthesia as the initial approach 1

2. Percutaneous reduction with intramedullary K-wires if closed reduction fails - This technique achieves better results than open reduction 1

   • Retrograde intramedullary K-wire fixation yields good anatomical reduction, faster rehabilitation, and easier hardware removal 4
   • In adults with Mason type II and III fractures, this technique produced good to excellent outcomes with mean DASH scores of 6.32 points and ESAS scores of 98.35 at 36-month follow-up 4
   • The technique allows reduction and stabilization without open surgery 5

3. Open reduction only as last resort - Reserve for cases where percutaneous techniques fail 1

   • Open reduction is a major contributing factor for poor outcomes 1
   • If open reduction is necessary, preserve medial periosteal continuity and vascular supply of the radial head through meticulous surgical dissection 6

Critical Rehabilitation Principles

• Initiate active finger motion exercises immediately following diagnosis to prevent stiffness, which is one of the most functionally disabling complications 2, 3
• Finger motion does not adversely affect adequately stabilized fractures 2, 3
• Early wrist motion is not routinely necessary following stable fracture fixation 7

Important Pitfalls to Avoid

• Meticulous assessment of intraoperative imaging is critical - The radial head can inadvertently invert 180° during closed manipulation, with the articular surface facing the radial shaft rather than the capitellum 8
• Avoid repeat manipulations that may cause iatrogenic injuries and stiffness 1
• Monitor for immobilization-related complications (skin irritation, muscle atrophy) which occur in approximately 14.7% of cases 9

Adjunctive Treatments

• Apply ice at 3 and 5 days post-injury for symptomatic relief 3
• Low-intensity ultrasound may improve pain and radiographic union in the short term, though long-term benefits are unproven 3