Radial head fracture fixation — rehabilitation protocol

Before starting, establish the fracture pattern, neck involvement, fixation stability, permitted motion and any additional repairs. Check whether the orthopaedic surgeon has specified extension limits, forearm position and a brace.

Following dislocation or ligament repair, stability precautions may matter more than the fixation method itself. Do not automatically allow full extension or unrestricted rotation. Brace settings and forearm position depend on the specific repair. ^[4]

A. Screws — a partial radial head fragment: with stable fixation and no associated injuries, begin early flexion, extension, pronation and supination. No routine angle restriction is imposed. Screws do not remove the need to protect the fracture from loading. ^[1]

B. LCP plate — particularly with neck involvement: early movement remains the aim when fixation is stable. Before increasing resistance, assess healing of the neck and, where involved, the articular part of the head. Comminution, bone loss and poor bone quality may delay progression. A plate alone does not justify prolonged immobilisation. ^[2],[3]

Both pathways: painful catching or a hard block to rotation requires surgical review; do not force through it. Mechanical impingement, rather than contracture alone, may be responsible. ^[1],[2]

Reviews: usually around days 10–14 for the wound, sensation and strength, movement and exercise guidance. Further visits follow the surgeon’s plan, with X-rays before loading increases; approximately weeks 6–8 and 12, more often if stability or healing is uncertain. ^[1],[2]

• More movement: satisfactory wound healing, tolerated movement, no increasing pain or swelling, no painful block or instability symptoms.
• Strengthening: clinical and radiographic healing, surgical clearance and fulfilment of additional repair precautions.
• Weight-bearing and greater effort: confirmed union, a stable elbow and forearm, and appropriate strength and control.

Surgeon–physiotherapist communication includes progress, pain, movement and difficulties with everyday tasks.

Goal: control pain and swelling, protect the wound and start safe movement.

• Sling or splint: briefly for comfort and soft-tissue protection, usually for the first few days. Remove for exercises as instructed. A brace is not mandatory for every stable isolated fracture. ^[1],[2]
• Rest: support the limb, elevate the hand and move the fingers and wrist. Avoid pressure on the wound.
• Flexion and extension: gentle active-assisted, then active movement in the permitted range. Support the upper arm; do not push the end range.
• Rotation: with the elbow near the trunk, usually bent about 90°, gently turn the palm up and down. After an additional repair, use the position specified by the surgeon.
• Dosage: short sessions several times daily. The physiotherapist sets repetitions to avoid increasing pain or swelling.

No loading: avoid lifting, pushing, pulling and supporting body weight. Light personal care only within the permitted limits. ^[1],[2]

Goal: steadily recover flexion, extension, pronation and supination.

• Continue physiotherapy and home exercises. Monitor extension without neglecting forearm rotation.
• Increase movement gradually. Avoid sudden movements, forceful passive stretching and pushing through a block.
• No forearm rotation against a weight, hammer or strong resistance band. Avoid opening tight jars and other forceful twisting tasks.
• No weight-bearing, push-ups, carrying shopping or pushing out of a chair through the operated limb. This also applies to loading it through crutches or a walking frame.

Review progress: increasing movement loss, a painful block or failure to improve requires reassessment. Do not increase force simply because another week has passed. ^[1],[2],[3]

Goal: maintain movement and start gradual strengthening when healing permits.

AO pathways generally protect the elbow from loading for 6–8 weeks. Completing this period does not automatically permit resistance: clinical assessment and X-rays are needed. With plate fixation of a neck fracture, neck union is particularly important. ^[1],[2],[3]

• Once cleared: low resistance, short sets and gradual training of elbow flexors, extensors and forearm rotators.
• Increase one demand at a time: resistance, repetitions or duration. Step back if pain or swelling increases after a session.
• Introduce substantial twisting resistance and weight-bearing later, after confirmed union and adequate limb control.

There is no universal weight allowance or separate fixed timetable based solely on the implant name.

Goal: restore strength, endurance and everyday function.

• After union and stability are confirmed, gradually increase functional loading and add work or recreational tasks.
• Heavy work, contact sports, throwing and activities with a fall risk require individual clearance, adequate strength and control.
• Driving requires safe steering and manoeuvres, no restrictive immobilisation or impairing medication, and an individual decision.

Readiness depends on function, not just the week number. Improvement may continue for months; full motion does not always return. Persistent limitation calls for assessment, not force. ^[4]