Comparison of early mobilization protocols in radial head fractures.

Objectives: We compared 2 different protocols of early mobilization with a protocol of delayed mobilization in patients with simple radial head fractures (B2.1 type of Orthopaedic Trauma Association Classification). An attempt to correlate certain characteristics of the radial head fractures with outcome was made.

Design: Prospective randomized comparative study.

Setting: Level 1 trauma center.

Patients/participants: One hundred eighty consecutive patients were randomly allocated into 3 different protocols.

Intervention: In the first group, immediate mobilization of the elbow joint was applied. In the second, a sling was used for 2 days and then active mobilization was introduced. The third protocol represented the control group where immobilization in a cast for 7 days before the mobilization was applied.

Main Outcome Measurements: Broberg and Morrey score, The American Shoulder and Elbow Surgeons-Elbow score, visual analogue scale, and grip and pinch strength were evaluated.

Results: The 2 protocols introducing early mobilization resulted in better outcome compared with immobilization. The first protocol resulted in worse pain in the first 3 days. Range of motion, strength, and functional outcome was better in patients allocated to the second protocol. These differences were more evident in displaced fractures. A fragment displacement of more than 4 mm and an angulation of more than 30 degrees proved to impair outcome.

Conclusions: Early mobilization of simple radial head fractures seemed to be a safe and an effective treatment option. It seems that a delay of 48 hours before early mobilization could be advantageous. Individualization of treatment in accordance to the characteristics of fracture could be a decisive factor for outcome.

Level Of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.