Early mobilisation for minimally displaced radial head fractures is desirable. A prospective randomised study of two protocols

Abstract

We compared two protocols of early mobilisation for minimally displaced radial head fractures through a single-blinded, prospective randomised trial. Sixty patients were randomly allocated to either immediate active mobilisation or 5-day delay before active mobilisation was commenced. Patients were reviewed at 7 days, 4 weeks and 3 months after injuries. A blinded observer assessed each patient. All fractures united by the third month. At the end of 7 days, the mobilisation group had less pain (visual analogue scale (VAS) 6 versus 7.6, P=0.002); greater flexion (mean 112 versus 98 degrees, P=0.0004); greater strength in supination (P<0.001) and better elbow function (Morrey Score: 54 versus 43, P=0.005). By the fourth week, both groups were comparable in all parameters and improvement continued into the third month. Mean limit of extension at the third month were 2.3 degrees in the immediate mobilisation group and 1.8 degrees in the delayed group (NS). All had excellent function on the basis of the Morrey Score. Immediate mobilisation did not adversely affect the outcome; the patients had less pain and better elbow function at 1-week post-injury. Pain, ranges of movement and function were similar by the fourth week post-injury.