Elbow: Radial Head Fracture Internal Fixation Rehabilitation Protocol

Physiotherapy exercises recommended for 4- 6 x per day pending swelling and pain

Fast vs Slow protocol:

  • Fast protocol: Begin early range of motion (ROM) as below: Fast protocol generally is the standard

  • Slow protocol: Delay in start date for ROM for fracture union – guided by operation report.

The following is the Fast protocol.

 

Phase 1: 0 to 7 - 14 days post operatively

On Surgical day 0 - 1

Cryotherapy, elevation, analgesia. Function in splint and sling

Initial exercises

  • Finger and shoulder gentle range of motion exercises

  • Cryotherapy for minimum first 4 days 3 x per day as baseline for 20 minutes

  • Check splint and wound review at 10 – 14 days post operatively

 

Phase 2 : 7 - 14 days to 8 weeks post operatively

Goal

Reduce swelling at the elbow. Wound healing. Attain full range of motion by week 6 - 8 post operatively

Action

Begin with passive assisted range of motion exercises

  • Flexion / Extension as tolerated or as instructed pending fracture pattern

  • Pronation / supination as tolerated

o    Patient positioned supine to begin with

  • No loading of the arm until x-ray review.

Progress to active range of motion as tolerated following trialling passive assisted

Avoid forceful end of range passive stretching

Phase 3: From 6 - 8 weeks post-operative to 12 weeks post-operatively

Goal

Attain full range of motion, try to aim to normal ADLs (Activities of Daily Living). Increase muscle strength and function.

Action

  • Continue range of motion exercises

  • Begin graduated loaded strength program start at 250g from week 6

o   Can include dynamic isometric and eccentric training, grip strength.

o   Progress as tolerated

  • No impact loading before 12 weeks post operatively 

Criteria to move to the next phase: Near full range of motion, no swelling or pain, good muscular control, and strength

Phase 4: From week 12 post-operatively

Goals

Return to sport and full loading for work duties

Action

  • Increase loading as tolerated

  • Strength training

  • Continue with range of motion exercises 

  • Instigate impact loading and sports specific / work specific training.

Criteria for return to sport: No swelling or pain with training activities

Test

Isokinetic strength testing >90% compared with the non-injured side