Radial Head Fracture Immobilization
For nondisplaced or minimally displaced radial head fractures, use a sling for 48 hours followed by immediate active range of motion exercises—avoid rigid splinting or casting beyond this brief period. 1
Initial Assessment
Evaluate for mechanical block to elbow extension and supination, which indicates a displaced fracture requiring different management 2. Key radiographic parameters to assess include:
- Fragment displacement >3-4mm 1, 3
- Angulation >30 degrees 1
- Number of fragments (>3 fragments suggests need for surgical intervention) 3
- Associated injuries to ligaments, other bones, or cartilage 4
Treatment Algorithm by Fracture Type
Nondisplaced or Minimally Displaced Fractures (Mason Type I)
Immobilization approach:
- Apply a sling for 48 hours only 1
- Begin active range of motion exercises immediately after the 48-hour period 1
- Do NOT use rigid casting or prolonged immobilization 1
Rationale: A 2013 prospective randomized trial demonstrated that a 48-hour delay before mobilization resulted in superior outcomes compared to both immediate mobilization (which caused worse pain in first 3 days) and 7-day cast immobilization (which resulted in worse range of motion, strength, and functional outcomes) 1.
Displaced Fractures Without Mechanical Block
Two treatment options exist with equivalent evidence:
- Conservative management with brief sling immobilization followed by early motion 3
- Open reduction internal fixation with headless cannulated screws 4
The 48-hour sling protocol is particularly advantageous for displaced fractures, as the benefit of early mobilization over casting is more pronounced in this subgroup 1.
Fractures Requiring Surgery
Surgical intervention is indicated when:
- >3 fragments with displacement (consider radial head replacement) 3
- Mechanical block to motion present 2, 3
- Associated ligament injuries requiring stability maintenance 3
Post-Treatment Mobilization
Active finger motion exercises should begin immediately to prevent stiffness, which is one of the most functionally disabling complications 5. Active elbow range of motion should begin after the initial 48-hour sling period for stable fractures 1.
Common Pitfalls to Avoid
- Avoid prolonged immobilization beyond 48 hours for simple radial head fractures, as this significantly impairs functional outcomes 1
- Do not miss associated injuries, particularly ligamentous disruptions, which fundamentally change management 4
- Displacement >4mm and angulation >30 degrees significantly impair outcomes and may warrant surgical consideration even in otherwise simple fractures 1
Follow-Up Monitoring
Obtain radiographic follow-up at approximately 3 weeks to confirm adequate healing 5. Monitor for complications including elbow stiffness, which occurs more frequently with prolonged immobilization 1.