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    The document discusses the rehabilitation of elbow fractures, including distal humeral fractures and olecranon fractures. It provides details on the definition, mechanism of injury, treatment methods, rehabilitation goals and prescriptions for the early treatment periods from days to weeks after injury. The focus is on restoring range of motion, strengthening muscles and progressing to functional activities as the bone heals over 12-24 weeks. Complications are also outlined.

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    The document discusses the rehabilitation of elbow fractures, including distal humeral fractures and olecranon fractures. It provides details on the definition, mechanism of injury, treatment methods, rehabilitation goals and prescriptions for the early treatment periods from days to weeks after injury. The focus is on restoring range of motion, strengthening muscles and progressing to functional activities as the bone heals over 12-24 weeks. Complications are also outlined.

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    The document discusses the rehabilitation of elbow fractures, including distal humeral fractures and olecranon fractures. It provides details on the definition, mechanism of injury, treatment methods, rehabilitation goals and prescriptions for the early treatment periods from days to weeks after injury. The focus is on restoring range of motion, strengthening muscles and progressing to functional activities as the bone heals over 12-24 weeks. Complications are also outlined.

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    26 views40 pages

    4 6028438121257896176 PDF

    Uploaded by

    احمد
    The document discusses the rehabilitation of elbow fractures, including distal humeral fractures and olecranon fractures. It provides details on the definition, mechanism of injury, treatment methods, rehabilitation goals and prescriptions for the early treatment periods from days to weeks after injury. The focus is on restoring range of motion, strengthening muscles and progressing to functional activities as the bone heals over 12-24 weeks. Complications are also outlined.

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    ‫بسم هللا الرحمن الرحيم‬

    REHABILITATION OF ELBOW
    FRACTURES
    Distal Humeral Fractures
    Olecranon Fractures
    Distal Humeral Fractures
    Definition
    Fractures of the distal humerus involve the metaphysis. They may or
    may not extend into the intraarticular surface.
    Lateral condyle fracture of the Y intracondylar fracture of the distal
    Oblique supracondylar. This fracture
    distal humerus. This is an humerus. This is a two-column
    is extraarticular and extracapsular.
    intraarticular single-column fracture
    Displaced transcondylar fracture. This is Lateral illustration of a transcondylar fracture bordering on a
    an intracapsular extraarticular fracture. supracondylar fracture. This fracture is extraarticular
    Mechanism of Injury
    Intraarticular fractures result from compression forces across the
    elbow in combination with a varus or valgus stress concentrate the
    force to either the medial or lateral column of the distal humerus.
    Supracondylar or transcondylar fractures (the most common
    extraarticular injury) generally result from a fall on an outstretched
    hand or a direct blow to the elbow.
    Treatment Methods
    Cast or Posterior Splint
    A long arm cast or posterior long arm splint is indicated for:
    •Nondisplaced fractures of the distal humerus
    •Displaced fractures able to closed reduction.
    In nondisplaced injuries, the extremity is immobilized for 2 to 3 weeks,
    followed by supervised active range of motion for another 4 to 6 weeks.
    For displaced fractures following closed reduction, immobilization is
    usually required for 4 to 6 weeks and rehabilitation of the elbow is
    started only when radiographic evidence of healing and clinical stability is
    present.
    The use of a hinged cast or functional brace should be considered
    when mobilization begins.
    Open Reduction and Internal Fixation
    Open reduction and internal fixation is the method of choice for open
    fractures.
    Rehabilitation goals
    A- Range of Motion
    Restore and maintain the full range of motion of the elbow.
    Protect the normal carrying angle of the elbow.
    Reestablish the full range of shoulder and hand motion.
    B- Muscle Strength
    Improve the strength of the following muscles: Elbow extensor, Elbow flexor,
    Forearm supinators and pronators, Wrist extensors, Wrist flexors, Deltoid.

    Expected Time of Bone Healing


    •8 to 12 weeks.

    Expected Duration of Rehabilitation


    •12 to 24 weeks.
    Associated problems
    The most common complication of fractures around the elbow are :
    1. Ischemic contracture (Volkmann contracture) due to
    damage/occlusion to the brachial artery and resulting in volar
    compartment syndrome.
    2. Neuropraxia to the ulnar nerve (most common), median nerve, or
    radial nerve.
    3. Malunion resulting in cubitus varus (varus deformity of the elbow).
    4. The development of myositis ossificans.
    5. The production of excess callus.

    Full extension of the elbow is the hardest to


    achieve.
    TREATMENT
    Treatment: Early to Immediate (Day of Injury to One Week)

    BONE HEALING
    Stability at fracture site: None.
    Stage of bone healing: Inflammatory phase.
    X-ray: No callus.
    Prescription
    Precautions:
    A. No internal or external rotation of the shoulder.
    B. No passive range of motion to the elbow.
    C. No pronation or supination.
    • Range of Motion: Gentle active elbow flexion and extension allowed
    for stable fractures treated with open reduction and internal fixation.
    No range of motion to the elbow if treated by other methods.
    • Muscle Strength: No strengthening exercises to the elbow.
    • Functional Activities: The uninvolved extremity is used in self-care
    and personal hygiene.
    • Weight bearing : None.
    Treatment: Two Weeks
    BONE HEALING

    Stability at fracture site: None to minimal


    Stage of bone healing: begin to reparative phase.
    X-ray: No to early callus. (Visible fracture line)
    Prescription
    Precautions: No internal or external rotation of the shoulder.
    •No passive range of motion to the elbow
    •No pronation or supination except for internal fixation

    Range of Motion:
    Gentle active elbow flexion and extension allowed for fractures only when
    treated with open reduction and internal fixation.
    Gentle assistive supervised active flexion and extension for non-displaced
    stable fractures.

    Muscle Strength: No strengthening exercises to the elbow.


    Functional Activities: continue the previous weeks.
    Weight bearing: None.
    open reduction and internal fixation
    Treatment: 4 to 8 Weeks
    BONE HEALING

    Stability at fracture site: Become stable once callus is observed


    Stage of bone healing: Reparative phase.
    X-ray: Bridging callus is visible.
    Prescription
    Precautions: Avoid rotational stresses across the elbow.
    Range of Motion:
    Active flexion and extension to the elbow.
    Avoid passive range of motion to reduce the risk of myositis ossificans

    Muscle Strength: begin isometric strengthening exercises to the elbow at 6


    weeks.

    Functional Activities: The patient uses the affected extremity for some self-
    care and personal hygiene.

    Weight bearing: None.


    Treatment: 8 to 12 Weeks
    BONE HEALING
    Stability at fracture site: Stable. Discontinue bracing, splinting, and
    sling with radio graphic evidence of union as early as 8 weeks.

    Stage of bone healing: Remodeling phase.

    X-ray: Callus is present but less than in mid-shaft.


    •The fracture line begins to disappear.
    Prescription

    Precautions: Avoid heavy lifting or pushing.

    Range of Motion: Active and passive range of motion to the elbow

    Muscle Strength: Progressive resistive exercises to the elbow


    musculature.

    Functional Activities: The involved extremity is used in self-care and


    functional activities.

    Weight bearing: Full weight bearing by 12 weeks.


    Olecranon Fractures
    An olecranon fracture involves the proximal end of the ulna.
    It may be extraarticular or intraarticular, Displaced or nondisplaced,
    transverse, oblique, comminuted, stable, or unstable.

    Intraarticular fractures account for the majority of olecranon


    fractures and are generally associated with joint effusions and
    hematomas.
    Extraarticular fractures include avulsion fractures and are most
    commonly seen in the elderly.
    Olecranon fractures may cause disruption of the extensor mechanism.
    •To test this, the patient should be asked to attempt extension of the
    elbow against gravity. If the patient is unable to do this, the extensor
    mechanism is interrupted and will require operative repair.
    • Olecranon fractures may be associated with coronoid fractures as
    well as elbow fracture/dislocations.
    Mechanism of Injury
    Direct blows are the most common injuries to the olecranon

    Falls on an outstretched hand with the elbow in flexion, leading to


    contraction of the triceps.

    High energy trauma, such as a car accident, may also cause an


    associated radial head fracture or elbow dislocation.
    Special Considerations of the Fracture
    Age
    •Elderly patients are more at risk for development of joint stiffness secondary
    to the fracture

    Articular Involvement
    •With intraarticular fractures, posttraumatic degenerative changes can be
    problematic, causing pain and limitation of motion, but they are not common.

    Associated Injury
    •Ulnar nerve neuropraxia or injury has been reported in approximately 2% to
    10% of olecranon fractures.
    Treatment Methods

    Closed Reduction and Splint or Cast


    •Used for non-displaced, stable fractures.

    Open Reduction and Internal Fixation


    •Used for displaced and comminuted fractures.

    Time of Bone Healing


    • 10 to 12 weeks.

    Expected Duration of Rehabilitation


    • 10 to 12 weeks.
    TREATMENT
    Treatment: Early to Immediate (Day of Injury to One Week)
    BONE HEALING

    Stability at fracture site: None.


    Stage of bone healing: Inflammatory phase.
    X-ray: No callus.
    Prescription
    Precautions: Avoid premature elbow motion.
    Range of Motion: No range of motion to the elbow or wrist in a cast or
    splint.
    •Gentle active elbow flexion and active range of motion to the wrist if
    treated surgically.

    Muscle Strength: No strengthening exercises to the elbow.


    •3 to 4 days after fracture, isometric exercises to the wrist within the cast.

    Functional Activities: The uninvolved extremity is used in self-care and


    personal hygiene.
    Weight bearing : None.
    Prescription
    Precautions: Avoid premature elbow motion.
    Range of Motion:
    No range of motion to the elbow or wrist in a cast or splint.
    Gentle active elbow flexion and active range of motion to the wrist if
    treated surgically.

    Muscle Strength: No strengthening exercises to the elbow.


    •3 to 4 days after fracture, isometric exercises to the wrist within the cast.

    Functional Activities: The uninvolved extremity is used in self-care and


    personal hygiene.

    Weight bearing : None.


    Treatment: Two Weeks
    BONE HEALING

    Stability at fracture site: None to minimal

    Stage of bone healing: begin to reparative phase.

    X-ray: No to early callus. (Visible fracture line)


    Prescription
    Precautions: Cast or splint: no extension to the elbow less than 90
    degrees.
    Range of Motion: the same as previous weeks.
    Muscle Strength:
    •No strengthening exercises to the elbow in extension.
    •Isometric exercises to the elbow in flexion in a cast.
    •Isometric exercises to the wrist.

    Functional Activities: The uninvolved extremity is used in self-care and


    personal hygiene.

    Weight bearing: None.


    Treatment: 4 to 6 Weeks
    BONE HEALING
    Stability at fracture site: Become stable once callus is observed
    Discontinue bracing, .splinting, and sling with radiographic evidence of
    union.

    Stage of bone healing: Reparative phase.

    X-ray: Bridging callus is visible


    Prescription
    Precautions: Avoid passive range of motion at the elbow.

    Range of Motion: Encourage active range of motion to the elbow in


    flexion and extension.

    Muscle Strength: Isometric exercises to the elbow and wrist in flexion


    and extension.

    Functional Activities: The patient uses the affected extremity for


    stability and light self-care.

    Weight bearing: None.


    Treatment: 6 to 8 Weeks
    BONE HEALING

    Stability at fracture site: With bridging callus, the fracture is usually


    stable.

    Stage of bone healing: reparative phase.

    X-ray: Bridging callus is visible


    Prescription
    Precautions: None.

    Range of Motion: Active to active-assistive range of motion in all


    planes to the elbow and wrist.

    Muscle Strength:
    •Resistive exercises to the elbow and wrist.

    Functional Activities: The patient uses the involved extremity for


    personal hygiene and self-care.

    Weight Bearing: Gradual weight bearing is allowed.


    Treatment: 8 to 12 Weeks
    BONE HEALING
    Stability at fracture site: Stable.
    Stage of bone healing: Remodeling phase.
    X-ray: More Callus is seen
    Prescription
    Range of Motion: Full active range of motion in all planes to the elbow
    and wrist.
    Muscle Strength: Progressive resistive exercises to the elbow
    musculature.
    Weight bearing: Full weight bearing by 12 weeks.
    References
    1. David J. Magee, Pathology and Intervention in Musculoskeletal
    Rehabilitation , 2nd ed. 2016
    2. Rehabilitation for the Postsurgical Orthopedic Patient, 3rd Edition.
    2013
    3. Treatment and Rehabilitation of Fractures. 2000
    4. David J. Magee , Orthopedic Physical Assessments Atlas And Video:

    5. Selected Special Testes and Movements , 5th ed. 2011


    6. James Wyss, Therapeutic programs for musculoskeletal disorders
    .2013

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