Weight-Bearing Restrictions for Nondisplaced Radial Neck Fractures
For patients with nondisplaced radial neck fractures, including those with osteoporosis or high fall risk, immediate weight-bearing as tolerated is recommended for the upper extremity, with no formal restrictions needed. 1
Upper Extremity Weight-Bearing Protocol
Immediate mobilization with self-directed home exercises is superior to formal physical therapy, demonstrating better early function at 6 weeks (lower DASH scores, p=0.021) with equivalent long-term outcomes. 1
No formal weight-bearing restrictions are necessary for nondisplaced or minimally displaced radial neck fractures, as the upper extremity naturally self-limits loading based on pain tolerance. 1
Patients should be instructed to use the affected arm for activities of daily living as comfort permits, progressing range of motion exercises independently. 1
Special Considerations for Osteoporosis and Fall Risk
All patients ≥50 years with fragility fractures require systematic osteoporosis evaluation, ideally through a Fracture Liaison Service, regardless of fracture location. 2
Vitamin D levels should be maintained ≥30-50 ng/mL with supplementation of 600-800 IU daily or more, and dietary/supplemental calcium intake of 1,000-1,200 mg daily. 3
DXA scanning should be performed to assess bone mineral density and guide pharmacologic osteoporosis treatment decisions, with height measurement at each visit to screen for vertebral compression fractures (≥2 cm prospective height loss warrants vertebral fracture assessment). 3
Monitoring and Follow-Up
Clinical healing typically occurs by 6 weeks, with patients demonstrating equivalent range of motion and pain scores whether they receive formal therapy or perform home exercises. 1
Return at 2-3 days if pain worsens, as this may indicate progression to displacement or other complications, though nonunion risk is low even in elderly patients. 4
Radiographic follow-up at 6 weeks is reasonable to confirm healing, though clinical examination (pain with rotation, functional use) is the primary determinant of recovery. 1
Critical Pitfall to Avoid
Do not prescribe formal physical therapy for isolated nondisplaced radial neck fractures, as this is not cost-effective and provides no benefit over self-directed exercises, while potentially delaying early functional recovery. 1 The key distinction here is that unlike lower extremity fractures where weight-bearing protocols are critical for preventing displacement 3, 5, upper extremity fractures allow patients to naturally self-regulate loading through pain-mediated feedback, making formal restrictions unnecessary and potentially counterproductive.