Elbow: Radial Head Fracture Internal Fixation With Lateral Ligament Repair Rehabilitation Protocol

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

Exercises in supine – start with exercises in pronation.

 

Phase 1: 0 - 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

At 14 days post operatively – 8 weeks post operatively

Change from splint to range of motion brace locked in 90 degrees with full free flexion range.

Phase 1 training

Goal

Reduce swelling at the elbow. Wound healing, Full range of motion by week 8 post operatively

Action

Supine passive range of motion exercises to begin with

  • Range of motion brace locked from 90 degrees with free flexion

o   Pronation range of motion exercises supine

  • Increase to 70 degrees at 3 weeks

  • Increase to 40 degrees at 4 weeks – begin gentle pronation and supination

  • Increase to 20 degrees at 5 weeks

  • Increase to full extension at 6 weeks - begin active range of motion

  • Avoid full supination in extension until week 8 post operatively

 

Phase 2 : From 8 - 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 gentle graduated loaded strength program start at 250g from week 6

  • No loading greater than 3kgs before 10 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 3: From a minimum of 12 weeks post-operative to 6 months post-operatively

Goals

Achieve full range of motion, increase muscle control and increase loading

Action

  • Increase loading as tolerated

  • Continue with range of motion exercises including full extension

Phase 4: From 6 - 12 months post-operatively

Goal

Return to sporting and work activity

Action

  • Strength training

  • Sport specific and activity of daily living specific training 

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

Test

Isokinetic strength testing >90% (95% for contact sports) compared with the non-injured side

Recommend waiting to 9 – 12 months to return to contact or loaded sporting activity to minimise the risk of re rupture.