What type of splint is recommended for a radial head fracture?

Splint Type for Radial Head Fracture

For nondisplaced or minimally displaced radial head fractures (Mason type I and minimally displaced type II), use a removable splint rather than rigid casting, as this provides adequate immobilization while allowing for early mobilization and preventing stiffness. 1, 2

Treatment Algorithm Based on Fracture Classification

Mason Type I (Nondisplaced, <2mm displacement)

• Apply a removable splint for initial immobilization 1, 3
• Functional conservative treatment is the standard approach for fractures with displacement less than 2mm 3
• The removable splint allows for early active finger and elbow motion exercises, which are critical to prevent stiffness—one of the most functionally disabling complications 1
• Duration: Maintain immobilization for approximately 3 weeks with radiographic follow-up to confirm healing 1

Mason Type II (Displaced 2-3mm without mechanical block)

• Removable splint is appropriate if displacement is ≤3mm and there is no rotational block to motion 1, 2
• If displacement exceeds 3mm or there is a mechanical block to forearm rotation, surgical fixation is indicated rather than splinting 1, 3
• The key clinical test: assess for any block to forearm rotation or elbow extension, which would necessitate surgical intervention 2

Mason Type III (Comminuted) and Complex Injuries

• Splinting alone is inadequate; these require surgical management with either open reduction and internal fixation or radial head arthroplasty 4, 2
• If associated ligamentous injuries are present (terrible triad, elbow instability), rigid surgical reconstruction is mandatory 3, 5

Critical Management Principles

Immediate mobilization protocol:

• Begin active finger motion exercises immediately after splint application to prevent stiffness 1
• Finger motion does not adversely affect adequately stabilized radial head fractures 1
• Early controlled elbow motion within pain-free range should be initiated as soon as tolerated 6, 2

Common pitfall to avoid: Do not use rigid casting for simple radial head fractures, as this significantly increases the risk of elbow stiffness without improving fracture healing 1, 2. The removable splint allows patients to perform range-of-motion exercises while still providing adequate protection.

Follow-up Requirements

• Obtain radiographs at 3 weeks post-injury to confirm adequate healing 1
• Repeat imaging at the time of immobilization removal 1
• Monitor for complications including skin irritation or muscle atrophy, which occur in approximately 14.7% of immobilization cases 1

Red flags requiring surgical consultation rather than splinting:

• Displacement >3mm on post-injury radiographs 1
• Any mechanical block to forearm rotation or elbow extension 2
• Associated elbow instability or ligamentous injury 3, 5
• Presence of terrible triad injury pattern (radial head fracture + coronoid fracture + elbow dislocation) 7