Treatment of Non-Displaced Radial Neck Fractures
Non-displaced radial neck fractures should be treated with brief immobilization (1-2 weeks maximum) followed by immediate initiation of self-directed home exercises, without the need for formal physical therapy. 1
Initial Management
Immobilization Protocol
- Immobilize for 3 weeks maximum with a cast or splint 2, 3
- Recent evidence demonstrates that 3 weeks of immobilization produces superior functional outcomes compared to 5 weeks, with significantly better patient-reported scores and no increase in complications 2
- For radial neck fractures specifically, even shorter immobilization (1-2 weeks) is appropriate given the need for early motion to prevent elbow stiffness 1
Pain Management
- Provide appropriate pain control throughout the treatment period to facilitate early mobilization 4, 5
- Adequate analgesia is essential to prevent stiffness and enable participation in rehabilitation 5
Rehabilitation Strategy
Early Motion Protocol
- Begin self-directed home exercises immediately after the brief immobilization period 1
- A prospective randomized trial demonstrated that patients performing home exercises had significantly better early function at 6 weeks (lower DASH scores, p=0.021) compared to formal physical therapy 1
- Formal physical therapy is not cost-effective and provides no additional benefit for isolated, minimally displaced radial head and neck fractures 1
Exercise Focus
- Initiate early range-of-motion exercises to prevent elbow stiffness, which is the primary complication of these injuries 1
- Emphasize elbow extension and supination movements, as limitations in these motions are characteristic of radial neck injuries 3
- Aggressive mobilization should begin once immobilization is discontinued, with early physical training and muscle strengthening 5
Follow-Up and Monitoring
Imaging Surveillance
- Obtain follow-up radiographs at 7-14 days to ensure maintenance of alignment 3
- Close monitoring with repeat imaging is necessary to detect any secondary displacement, though this occurs rarely (approximately 1-2% of cases) 2
- Regular radiographic monitoring is essential to detect loss of reduction early 5
Key Clinical Pitfalls to Avoid
Common Errors
- Do not prescribe formal physical therapy for isolated non-displaced radial neck fractures, as it provides no benefit over home exercises and increases costs unnecessarily 1
- Avoid prolonged immobilization beyond 3 weeks, as this leads to worse functional outcomes and increased stiffness 2, 1
- Do not underestimate the importance of early motion - elbow stiffness is the primary source of disability in these fractures 1
- Ensure adequate pain control to facilitate early mobilization and prevent frozen elbow 5
Special Considerations by Patient Factors
Age-Related Factors
- The treatment approach described above applies to adult patients of all ages 1
- For patients over 50 years, systematically evaluate for osteoporosis risk and consider secondary fracture prevention measures 4, 6
Activity Level
- High-demand patients benefit particularly from early mobilization protocols 1
- The biological capacity to heal is excellent with conservative management in physiologically healthy individuals 6
When to Consider Alternative Management
Indications for Surgical Referral
- Displacement develops on follow-up imaging despite initial non-displaced appearance 2
- Persistent limitations in elbow extension and supination after 6-8 weeks of conservative management 3
- Associated injuries requiring surgical intervention 3
Note: The evidence provided focuses primarily on distal radius fractures rather than radial neck fractures specifically. However, the principles of brief immobilization and early motion apply even more strongly to radial neck fractures given the proximity to the elbow joint and high risk of stiffness. The single high-quality randomized trial specifically addressing radial neck fractures 1 provides the strongest evidence for the recommended approach.