If you have a radial head fracture (in the elbow) and are wondering about the rehabilitation process, healing and recovery time, potential complications, and immobilization period, it’s completely normal to have these questions. When receiving immediate medical attention, there may not have been enough time to address all your concerns, and additional questions may arise over time.
In this article, I have compiled answers to the most common questions from my patients, healthcare professionals, and online users regarding radial head fractures. To provide these answers, I draw upon my experience as a physiotherapist, as well as findings from international scientific publications.
References will be provided at the end of the article. Enjoy!
Last update: August 2023
What does a radial head fracture look like?
Radial head fractures belong to the broader category of elbow fractures. They are the most common type of elbow fracture, accounting for one-third of all elbow fractures (source: StatPearls 2022).
The elbow is composed of three bones:
- Part of the humerus, the bone of the upper arm.
- Part of the radius, one of the two bones in the forearm.
- Part of the ulna, the other bone in the forearm.
When a fracture occurs in the radius bone at the level of the elbow, it involves the radial head. The radial head is the portion of the radius bone that is closest to the elbow and contributes to the elbow joint.
Different types of fracture
The radial head (or head of the radius, they are the same thing) can be fractured in different ways, just like any other bone.Here are the main types of radial head fractures:
- Craked radial head fracture: This is a “small” fracture.
- Simple fracture or non-displaced radial head fracture: The fracture line is more significant than in a crack, but there is little separation between the two broken bone ends.
- Complex radial head fracture (these may take longer to heal):
- Displaced fracture: There is a significant separation between the two fragments of bone on either side of the fracture line.
- Comminuted fracture: There are multiple fracture lines, and the radial head is broken in several places.
- Open fracture: A portion of the bone has penetrated through the different layers of tissue and protrudes through the skin. These fractures carry a higher risk of infection.
Dislocation of the elbow may be associated with these fractures. Less commonly, there may be nerve or vascular injuries.
Other bones can also be broken simultaneously with the radial head, such as another part of the radius, the ulna, or the humerus, among others.
How can you determine the type of fracture you have? It will be mentioned in your radiography report or in the consultation report from the healthcare professional who diagnosed the fracture.You may also sometimes see something like “Mason I,” “Mason II,” or “Mason III” written. This refers to the severity of the fracture according to a classification often used by doctors.
In this X-ray, a displaced and comminuted fracture of the radial head is visible. The bone fragment is far from its original position. This type of fracture is classified as “Mason III” and may require surgery.
In practice, this classification does not significantly change the overall management, which follows similar guidelines. Regardless of the type and severity of the fracture, physical therapy is often necessary, either a few sessions shortly after the radial head fracture (less common) or in the weeks following the injury (more frequent).
What are the symptoms?
A radial head fracture is usually hard to miss. The most common symptoms include:
- Significant pain in the elbow, which may radiate to the arm and forearm. The arm is often rendered unusable.
- Difficulty bending or straightening the elbow.
- Swelling (edema) of the elbow.
- Bruising (hematomas) around the elbow, arm, or forearm.
Only an X-ray (or another imaging examination) can confirm the diagnosis.
What is the treatment for a radial head fracture?
There are two main types of treatment for a radial head fracture:
- Conservative treatment (most common): No surgery is performed, but immobilization is often required, followed by rehabilitation.
- Surgical treatment: Surgery is performed shortly after the fracture (often on the same day). Immobilization or rehabilitation follows the surgery.
The probability of requiring surgery increases with the complexity or open nature of the fracture.
Surgery is often performed to reduce and stabilize the fracture, which means that the broken bone fragments are realigned to their normal position, and hardware is used to maximize the chances of keeping them in place.
Here are the main types of surgical procedures for a fractured radial head:
- Resection: The fractured radial head is removed.
- Open reduction and internal fixation (ORIF): The fracture is surgically realigned, and screws, possibly plates, are used to fixate the bone.
- Radial head replacement: The damaged radial head is replaced with a metallic or polyethylene prosthesis (or occasionally other materials).
📚 Source: Cochrane, 2013; Burke, 2022
Duration of immobilization?
Whether you have undergone surgery or not, you will likely have a period of “immobilization.” However, this immobilization is relative, meaning it is shorter and less strict compared to other types of fractures.
Why is that? Because the elbow can quickly become stiff if it remains in the same position for too long. Stiffness of the elbow is, in fact, the most common complication following a radial head fracture.
Relative immobilization often involves keeping the elbow in a flexed (bent) position.
Each medical team may have its own perspective on the ideal duration of immobilization.
A study followed 81 individuals aged 14 to 87 with a radial head fracture (Mason stage 1 or 2) for several years. One group did not undergo immobilization, another group had the elbow immobilized in flexion for 2 weeks in a cast, and the third group had the elbow immobilized in extension for 2 weeks in a cast. In all three situations,
- the pain,
- elbow mobility,
- and ability to use the arm were similar.
There were no complications in any of the three situations, and all individuals were able to resume their work and lifestyle as before.
📚 Source: Cochrane 2011
For simple elbow fractures, elbow immobilization may not always be necessary. The elbow can be mobilized from the beginning, depending on the level of pain. The medical team familiar with your case will determine with you what is best to do.
When immobilization is deemed necessary, it often lasts:
- 1 to 3 weeks
- 6 weeks (until a follow-up X-ray)
- Very rarely longer than 6 weeks
Regarding rehabilitation, only the elbow may need immobilization if required, while other joints such as the wrist and shoulder should continue to move!
Immobilization is intended to promote healing and provide pain relief.
What type of splint to wear?
Doctors or physical therapists may prescribe a splint for you.
For a radial head fracture, the preferred options are often a long-arm splint or a simple sling.
Sometimes, in addition to the splint, a plaster cast or a fiberglass cast may be applied.
The splint can be worn at night, especially to alleviate pain.The splint can be removed for bathing and to perform rehabilitation exercises.
How does physical therapy for a radial head fracture work?
Physical therapy sessions are often prescribed after a radial head fracture. Physical therapists are there to help you gradually regain the normal use of your arm.
Before the fracture heals:The first 6 weeks
During the initial weeks after the fracture, rehabilitation has two main objectives:
- Limiting the loss of strength and flexibility in the arm.
- Providing guidance to help you navigate through this phase, including advice on adapting your lifestyle and relieving pain.
Your physical therapist will likely demonstrate exercises to move the other joints not affected by the fracture, such as the wrist, hand, and shoulder.
They will also show you specific movements for the elbow based on your pain level and the instructions you have received. Together, you will work on gradually increasing the frequency and range of motion of these movements.
To alleviate pain, various methods may be suggested in addition to medication, such as massage, cold therapy, transcutaneous electrical nerve stimulation (TENS), or ultrasound. The effectiveness of these treatments beyond the placebo effect is uncertain, but they generally have minimal side effects.
The splint and the position of the elbow and forearm against the abdomen are also pain management solutions. Additionally, finding a comfortable position with the help of cushions can provide relief.
After bone healing
A few weeks after the fracture, you will have a follow-up X-ray. Generally, you will be informed that the fracture has healed well or is on the right track.
In this case, you can transition to a more active phase of rehabilitation. The goal is to regain the ability to perform all the activities you did before with your arm.
Exemple of exercises after a radial head fracture:
- Regaining full flexion (bending) and extension (straightening) of the elbow.
- Regaining supination (turning the palm upward) and pronation (turning the palm downward).
These exercises should be performed daily once your orthopedic surgeon, doctor, or physical therapist gives you the green light to start moving your elbow. Aim for approximately 10 repetitions several times a day, or even every hour. The exercises should not cause pain, or at most, a mild discomfort at the end of the movement that quickly subsides after exercise. If it’s too challenging, you can use your uninjured arm to assist the movement.
To achieve these goals, you will likely need to regain flexibility in the various joints (not only the elbow but also the shoulder) and rebuild strength.
Physical therapy sessions may sometimes begin during this phase, focusing mainly on active exercises. The aim is for you to incorporate these exercises into your daily routine at home.
A typical physical therapy session lasts around 30 minutes, 2 or 3 times per week. That leaves plenty of hours for self-rehabilitation!
What is the healing time for a radial head fracture?
The typical duration for bone consolidation is approximately 1.5 months, and this applies to the radius as well.
However, the actual timeline depends on various factors, and only an X-ray can determine the progress of the healing process.If you are a smoker, it’s important to note that tobacco consumption often delays bone healing and the healing of other tissues as well. Some individuals choose to reduce or quit smoking during this period.
While it takes about 1.5 months for healing, it’s still possible to move a non-consolidated bone with certain precautions in place!
However, the completion of bone healing does not mean that you can immediately resume all activities as before. It’s important to gradually reintroduce movements and activities so that your body can readjust and adapt.
Is it normal to experience pain after a radial head fracture?
Whether you have undergone surgery or been immobilized for a radial head fracture, it is common to experience pain, even with the use of pain medications. The pain is typically significant in the first few days following the fracture but rapidly decreases in intensity within the first week.
The level of pain is not necessarily indicative of the severity of the fracture. In other words, experiencing severe pain does not necessarily mean that you have a highly severe fracture that should cause concern.
Pain can persist for several weeks, even at rest without moving the arm. This is not necessarily a cause for alarm, especially if it does not prevent you from sleeping or carrying out your daily activities.
Pain may temporarily increase again 3-6 weeks after the radial head fracture when you start using the arm more. However, it will decrease again until it completely disappears over the course of a few weeks or months.
What are the possible long-term effects?
It is important to stay positive and keep in mind that many people who have had a radial head fracture do not experience any long-term effects or sequelae.
Most of the time, individuals are able to resume their daily activities, work, and sports.The elbow joint is quite mobile, allowing for approximately 150° of flexion/extension and rotation of the forearm in pronation/supination.
When there is a fracture involving this joint, such as a radial head fracture, there is a small risk of some stiffness in the joint (3 to 20% of cases, according to ortho-bullets.com).
Some individuals may not regain the full range of motion in flexion or extension that they had before the fracture. However, this does not necessarily hinder them from resuming all desired daily activities or participating in sports.
Some individuals may also experience:
- Medium to long-term pain
- Delayed or absent consolidation (non-union)
- Earlier onset of elbow arthritis, although the elbow is far from being the joint most commonly affected by arthritis.
Individuals who undergo surgery may experience certain complications, although these are generally rare:
- Secondary displacement (hardware failure)
Sequelae after radial head fracture are more of an exception than the rule. When present, they primarily involve stiffness or pain, but they do not necessarily hinder daily activities.
What is the recovery time for a radial head fracture?
The recovery time can vary depending on the definition of “recovery” and individual variations based on the severity of the fracture and other factors.
Here are some indicative timelines that I have observed in my patients when I did not find data from a larger sample beyond my own professional experience:
|Time from the day of the fracture||Stage|
|2 weeks||Significant reduction in pain|
|6-12 weeks||Bones are well consolidated|
|2-12 weeks||Gradual regaining of good elbow mobility|
|2-12 weeks||Resumption of daily activities involving the arm (household chores, dressing, eating, cooking, gardening, etc.)|
|1-2 months||Ability to drive a car, ride a bicycle|
|3-6 months||Gradual return to low-impact sports (running, soccer, etc.)|
|5-9 months||Gradual return to sports involving greater arm exertion (tennis, swimming, handball, etc.)|
When to drive after a radial head fracture?
There are varying opinions regarding the resumption of driving a car after a radial head fracture.
The traffic regulations do not provide specific guidelines on this matter. It is the responsibility of the driver to ensure that their condition is compatible with safe and reactive driving.
There is no formal contraindication to driving with a splint. However, in theory, you should ensure that you can react as effectively as you would in a normal state, which is unlikely with an immobilized arm.
Once the splint is removed, if the act of turning the steering wheel is no more painful than at rest, there is little risk that driving will exacerbate the pain. However, it is recommended to start with short distances (a few minutes).
In general, the patients I have cared for after a radial head fracture resumed driving between 4 and 10 weeks after the fracture.
When seeking the opinion of orthopedic surgeons regarding resuming driving after a radius or ulna fracture, the general response is to wait until the plaster cast or external fixator is removed (Danilkowitz 2020).
Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !
If you feel the need to learn more about the recovery period after this type of fracture, I wrote this guide in eBook format:
You may also like:
There are several hundred scientific publications on radial head fractures. This means that we know quite a lot about their evolution and how to optimize it!
Gao Y, Zhang W, Duan X, Yang J, Al-Qwbani M, Lv J, Xiang Z. Surgical interventions for treating radial head fractures in adults. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD008987. DOI: 10.1002/14651858.CD008987.pub2
Harding P, Rasekaba T, Smirneos L, Holland AE. Early mobilisation for elbow fractures in adults. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD008130
Patiño JM, Saenz VP. Radial Head Fractures. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Burke CE,
McKegg PC, Wong AL, DeLeon GA, Gupta J, Healey K, Enobun B, O’Hara NN, O’Toole RV, Pensy RA, Langhammer CG, Eglseder WA. Association of Radial Head Fracture Treatment With Long-Term Function.
Hand (N Y). 2022 Jul 27:15589447221109631. doi: 10.1177/15589447221109631. Epub ahead of print. PMID: 35898119.Ortho-bullets.com, Radial Head Fractures, 2022.Conduite.
Danilkowicz, R., Tainter, D., & Gage, M. (2020). Return to driving after fracture an overview of current recommendations. Current Orthopaedic Practice, 31(4), 408–411. doi:10.1097/bco.0000000000000877
Picture : NHS
By Nelly Darbois
I love to write articles that are based on my experience as a physiotherapist and extensive research in the international scientific literature.
I live in the French Alps 🌞❄️ where I work as a physiotherapist and scientific editor for my own website, where you are.