What is the initial treatment for a patient with a nondisplaced fracture of the radial head?

Initial Treatment for Nondisplaced Radial Head Fracture

Apply a removable splint immediately and begin active finger motion exercises right away to prevent stiffness while allowing adequate fracture stabilization. 1

Immobilization Strategy

• Use a removable splint rather than rigid casting for nondisplaced or minimally displaced radial head fractures (displacement ≤3mm with no rotational block to motion). 1
• Removable splints provide adequate immobilization while facilitating early mobilization, which is critical for preventing elbow stiffness—the most functionally disabling complication of these fractures. 1
• Avoid rigid casting, as it increases the risk of stiffness without improving fracture stability in nondisplaced fractures. 1

Immediate Mobilization Protocol

• Start active finger motion exercises immediately after splint application. 1
• Finger motion does not adversely affect adequately stabilized radial head fractures and prevents stiffness. 1
• Early wrist motion is not routinely necessary following stable fracture fixation. 2
• Research supports that early mobilization (within 48 hours) results in better range of motion, strength, and functional outcomes compared to immobilization for 7 days. 3

Follow-Up Imaging Schedule

• Obtain radiographs at 3 weeks post-injury to confirm adequate healing. 1
• Repeat imaging at the time of immobilization removal is necessary. 1

Red Flags Requiring Surgical Consultation

• Displacement >3mm requires surgical fixation rather than conservative management. 1
• Terrible triad injury pattern (radial head fracture + coronoid fracture + elbow dislocation) requires immediate surgical consultation, not splinting. 1
• Rotational block to motion indicates a more complex fracture requiring surgical evaluation. 1

Monitoring for Complications

• Watch for immobilization-related complications including skin irritation or muscle atrophy, which occur in approximately 14.7% of cases. 1
• Assess for limitations in elbow extension and supination, which may indicate more significant injury than initially apparent. 4

Common Pitfall to Avoid

The most critical error is rigid immobilization for extended periods, which leads to debilitating stiffness. The evidence strongly favors removable splinting with immediate active motion for nondisplaced fractures, as the radial head is an important elbow stabilizer that requires early functional rehabilitation to maintain joint mechanics. 1, 5