Radial Head Fracture Immobilization
For radial head fractures, use a simple sling for 48 hours followed by immediate active mobilization rather than a shoulder mobilizer or prolonged immobilization. 1, 2
Recommended Immobilization Protocol
The optimal approach is a removable splint or simple sling for 2 days, then begin active range of motion exercises. 1, 2 This protocol consistently produces superior outcomes compared to rigid immobilization or immediate mobilization without any rest period.
Evidence Supporting 48-Hour Sling Use
A prospective randomized trial of 180 patients demonstrated that a 2-day sling followed by active mobilization resulted in better range of motion, strength, and functional outcomes compared to both immediate mobilization and 7-day cast immobilization 2
The 48-hour delay protocol showed particular advantage in displaced fractures (>4mm displacement or >30 degrees angulation), where it significantly improved outcomes 2
Immediate mobilization without any sling period resulted in worse pain during the first 3 days, though outcomes eventually equalized 2
A separate randomized trial of 60 patients confirmed that immediate mobilization produced less pain at 7 days compared to 5-day immobilization, but both groups had equivalent outcomes by 4 weeks 3
Why Not a Shoulder Mobilizer
Avoid rigid casting or prolonged immobilization beyond 48 hours, as this leads to worse functional outcomes. 2, 4 The American College of Radiology specifically recommends removable splints rather than rigid casting for nondisplaced or minimally displaced radial head fractures 1. Cast immobilization should be avoided entirely for Mason type I fractures 4.
Critical Implementation Details
Begin active finger motion exercises immediately after splint application, even during the initial 48-hour period. 1 Finger motion does not adversely affect adequately stabilized radial head fractures 1.
After 48 hours, remove the sling and initiate active elbow mobilization exercises. 2, 4 Physical therapy support may be beneficial if mobilization is inadequate 4.
Fracture-Specific Considerations
This protocol applies to:
- Nondisplaced fractures (Mason type I) 1, 4
- Minimally displaced fractures (≤3mm displacement, no rotational block) 1
Do not use this conservative approach if:
- Displacement >3mm with mechanical block to motion 1, 5
3 fragments present 5
- Terrible triad injury pattern (radial head fracture + coronoid fracture + elbow dislocation) - requires immediate surgical consultation 1
Follow-Up Requirements
Obtain radiographs at 3 weeks post-injury and at the time of immobilization cessation to confirm adequate healing. 1, 6
Common Pitfall to Avoid
The most critical error is prolonged immobilization beyond 48 hours. 2, 4, 7 A retrospective study of 70 patients requiring surgical revision after conservative treatment found that 38 cases were initially immobilized for an average of 3.4 weeks, resulting in posttraumatic elbow stiffness in 53 patients 7. This demonstrates that excessive immobilization is a primary cause of poor outcomes requiring subsequent surgical intervention.