Preventing Joint Stiffness After Radial Head Fracture: Essential Tips

How to prevent joint stiffness in the early stages of a radial head fracture?

Subject: I slipped and fractured my right radial head on October 12.
The X-ray is as follows: https://drive.google.com/file/d/1vRAkhA6uLM8Uqqh5XZ9PjkQNRnN0kFZt/view?usp=sharing.
I have visited the doctor three times, and the diagnoses are as follows:
1.
Shuanghe Orthopedics (October 12, afternoon): X-ray revealed a non-displaced radial head fracture.
Medical advice: Ask the doctor if treatment is necessary.
The doctor stated that this is a linear fracture and careful observation is sufficient.
I was advised to manage swelling and avoid painful movements, with no medications or immobilization prescribed.
2.
Tri-Service General Hospital Orthopedics (October 12, evening): A repeat X-ray confirmed the non-displaced radial head fracture.
Medical advice: The affected area must be immobilized using either a cast, splint, or triangular bandage.
Pain relief and anti-inflammatory medication were prescribed, and I chose to use a triangular bandage.
3.
National Taiwan University Orthopedics (October 13, afternoon): A repeat X-ray confirmed the non-displaced radial head fracture.
Medical advice: Surgery is not required, but a long arm cast is necessary to prevent displacement.
However, there is an 80% chance of residual elbow extension and flexion issues.
After strong recommendation from the physician, I opted for the long arm cast.
Currently (October 16), there is no swelling or pain in the affected area.
After reviewing numerous online cases, it appears that elbow casting often leads to joint stiffness and limited rehabilitation outcomes, which could significantly impact my work and daily life.
I would like to ask Director Shi the following questions:
1.
What measures can be taken to reduce the likelihood of joint stiffness? For example, would surgical internal fixation be advisable, or could the cast be removed after a maximum of two weeks in favor of a triangular bandage combined with extension and flexion exercises?
2.
I have been attempting to move my fingers, wrist, and shoulder joints without significant pain.
Is it safe to continue these movements?
3.
Given the differing diagnoses from the three physicians, which clinic should I return to for follow-up? Or do you have any other physician recommendations?
I sincerely appreciate your assistance, Director Shi!

Kevin, 40~49 year old female. Ask Date: 2022/10/16

Dr. Shi Guozheng reply Orthopedics

1.
Surgery is not necessary; stiffness may still be present even after surgery.
2.
It is possible.
3.
It is more appropriate to adopt the recommendation of a third physician, as the diagnoses are all the same.

Reply Date: 2022/10/16

More Info

Preventing joint stiffness after a radial head fracture is a crucial aspect of recovery, especially considering the potential for long-term complications such as limited range of motion. Here are some essential tips and considerations based on your situation and general medical knowledge.

1. Early Mobilization
One of the most effective ways to prevent stiffness is to start gentle mobilization as soon as it is safe to do so. After a radial head fracture, it is essential to follow your physician's advice regarding when to begin movement. If your doctor has indicated that it is safe, you can start with passive range of motion exercises for your elbow, wrist, and fingers. This can help maintain flexibility and circulation in the area.

2. Gradual Increase in Activity
As you progress, gradually increase the intensity and range of your exercises. Begin with simple movements like flexing and extending your fingers and wrist. Once you feel comfortable, you can incorporate elbow movements. The key is to listen to your body; if you experience pain, it may be a sign to ease back on the intensity.

3. Use of Splints or Supports
While your doctor has recommended a long arm cast to prevent movement, it is essential to balance immobilization with the need for movement. If your doctor allows, consider transitioning to a splint or brace after a couple of weeks, which can provide support while still allowing for some movement. This can help reduce stiffness while protecting the fracture site.

4. Physical Therapy
Engaging in physical therapy can be beneficial. A physical therapist can provide tailored exercises that focus on regaining strength and flexibility in your elbow and surrounding joints. They can also use modalities such as ultrasound or electrical stimulation to help reduce pain and promote healing.

5. Pain Management
Managing pain effectively can also facilitate better participation in rehabilitation exercises. If you are experiencing significant discomfort, discuss pain management options with your physician. This may include over-the-counter pain relievers or prescribed medications.

6. Nutrition and Hydration
Proper nutrition plays a role in recovery. Ensure you are consuming a balanced diet rich in vitamins and minerals, particularly calcium and vitamin D, which are essential for bone health. Staying hydrated is also crucial for overall recovery.

7. Monitor Progress
Keep track of your progress and any changes in pain or mobility. If you notice increased stiffness or difficulty moving your elbow, consult your physician. They may recommend adjustments to your rehabilitation plan or further imaging studies to assess the healing process.

8. Follow-Up Care
Regarding your question about which physician to follow up with, it is advisable to continue with the physician whose recommendations you feel most comfortable with and who has provided consistent advice. If you have concerns about differing opinions, consider seeking a second opinion from a specialist in orthopedic rehabilitation.

Conclusion
In summary, preventing joint stiffness after a radial head fracture involves a combination of early mobilization, gradual increase in activity, appropriate use of supports, physical therapy, effective pain management, proper nutrition, and consistent monitoring of your recovery. Always consult with your healthcare provider before making changes to your rehabilitation plan, and prioritize open communication about your concerns and progress. This proactive approach will help you regain function and minimize the risk of long-term complications.

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