Conservative Nonsurgical Treatment for Non-Displaced or Minimally Displaced Radial Head Fractures
Non-displaced and minimally displaced radial head fractures should be treated non-operatively with early active mobilization. 1, 2
Treatment Protocol
Immobilization Options
- Pressure bandage or upper arm cast are the standard immobilization methods 3
- The specific type of immobilization (pressure bandage vs. cast) does not significantly affect long-term functional outcomes 3
- Immobilization should be brief to facilitate early mobilization 4
Early Active Range of Motion
- Early active ROM is the cornerstone of conservative management for isolated, minimally displaced fractures without mechanical block 4
- Begin mobilization as soon as pain allows, typically within days of injury 1, 2
- The goal is to prevent stiffness while allowing fracture healing 4
Key Clinical Considerations
When Conservative Treatment is Appropriate
- Displacement ≤2 mm without mechanical block to pronation/supination 1
- No mechanical block to forearm rotation on clinical examination 1, 4
- Isolated fracture without associated ligamentous injuries or other fractures 2, 4
Important Caveats
- Mechanical block to pronation/supination is an absolute contraindication to conservative treatment and requires surgical intervention 1
- Associated injuries (ligamentous tears, other fractures) change management significantly and may require surgery even for minimally displaced radial head fractures 2
- Carefully assess for associated injuries including ligamentous disruption, which commonly accompanies radial head fractures 2
Expected Outcomes
Functional Results
- Conservative treatment yields similar functional outcomes to operative treatment at 1 year for Mason type 2 fractures 5
- 42% of patients achieve perfect function (DASH score = 0) at long-term follow-up 3
- 80% of patients have minimal to no disability (DASH score ≤10.1) 3
- However, 20% may experience persistent limitations in activities of daily living 3
Comparative Evidence
- A 2021 randomized controlled trial demonstrated no functional difference between operative fixation and nonoperative treatment with pressure bandage for isolated Mason type 2 fractures at 3,6, and 12 months 5
- Both treatment approaches had low complication rates 5
Clinical Pitfalls to Avoid
- Do not miss a mechanical block: Always test active pronation and supination before committing to conservative treatment 1, 4
- Screen for associated injuries: Comminution and complete loss of cortical contact are associated with high rates of ligamentous or other bony injuries that may require surgical management 1
- Avoid prolonged immobilization: Extended casting increases stiffness risk without improving fracture healing 4