What is the recommended splint for an isolated radial head fracture?

Best Splint for Radial Head Fracture

For isolated, minimally displaced radial head fractures without mechanical block to motion, early active range of motion without rigid immobilization is the recommended treatment approach, making a removable splint or sling for comfort the most appropriate option. 1, 2, 3

Treatment Algorithm Based on Fracture Characteristics

Minimally Displaced or Nondisplaced Fractures (Mason Type 1)

• These fractures should be treated with early active range of motion rather than rigid splinting. 1, 2, 3
• A removable splint or simple sling may be used for initial comfort during the first few days, but the priority is early mobilization to prevent stiffness. 1, 3
• Active finger motion exercises should be initiated immediately following diagnosis to prevent stiffness, which is one of the most functionally disabling complications. 4

Partial Displaced Fractures Without Mechanical Block (Mason Type 2)

• If there is no mechanical block to elbow motion, these can be managed conservatively with early active ROM. 1, 2
• A posterior splint maintaining the elbow at 90 degrees may be used for initial comfort, but should not restrict early motion exercises. 5
• The key assessment is whether the patient can achieve full elbow extension and forearm rotation—if yes, proceed with early mobilization rather than rigid immobilization. 3

When Splinting is NOT Appropriate

• Displaced fractures with >3 fragments require surgical management (radial head replacement), not splinting. 1, 6
• Any fracture causing mechanical block to motion requires surgical intervention (fragment excision or ORIF), not conservative splinting. 1, 3
• Fractures associated with elbow instability, ligament injuries, or forearm fractures need surgical stabilization. 1, 2

Duration and Follow-up

• If a splint is used for comfort, radiographic follow-up should occur at approximately 3 weeks to confirm adequate healing. 4
• The splint should be removable to allow for active ROM exercises multiple times daily. 4

Critical Pitfalls to Avoid

• Do not rigidly immobilize isolated, stable radial head fractures—stiffness is the primary concern and complication with these injuries. 1, 2, 3
• Always assess for associated injuries including elbow dislocation, Essex-Lopresti injury (distal radioulnar joint disruption), medial collateral ligament injury, and coronoid fractures before committing to conservative management. 7, 1, 2
• Test for mechanical block by assessing full elbow extension and forearm rotation before deciding on nonsurgical treatment. 3
• Monitor for complications including skin irritation and muscle atrophy, which occur in approximately 14.7% of immobilization cases. 4