8-A836A-2018-Books-00085-Green chapter 19-ROUND1

Chapter 19 • Rehabilitation After ORIF of Elbow Dislocations

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patient early about the expected ROM losses, especially elbow extension. A loss of 15 ° of elbow extension is not an uncom- mon sequela of even simple elbow dislocations. Patients are splinted in the operating room and placed in a sling. The splint rests the soft tissue to help reduce swelling and protect the repair. The splint is typically discontinued 7 to 10 days after surgery. The splint can be replaced with either a custom-molded orthoplast removable splint, or a prefabri- cated brace, which can be removed for hygiene and permit early ROM exercise while protecting the repair (Figure 19.4). Gentle active and active assisted exercises are typically initi- ated within the first 7 to 10 days after surgery. Active range of motion (AROM) rather than passive range of motion (PROM) is advocated to take advantage of the compressive stabilizing forces of the muscles surrounding the elbow. The patient is encouraged to remove the orthosis and perform these exercises at frequent intervals throughout the day. As the bone and soft tissues begin to heal, the ROM can be progressed and light functional activities can be initiated. Strengthening is begun once the joint is declared stable by the physician. In general, Figure 19.3  A–C , Illustrations of reconstruction of the lateral ulnar collateral ligament through an extended Kocher’s approach. (Reproduced with permission from Morrey BF. Acute and chronic instability of the elbow. J Am Acad Orthop Surg 1996;4(3):117–128, and with permission from the Mayo Foundation for Medical Educa- tion and Research, Rochester, MN.)

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Postoperative Rehabilitation Although there is no “one-size-fits-all” approach to rehabilita- tion after operative fixation of elbow instability injuries, there are general principles that can be applied and utilized in indi- vidual cases. The initial postoperative management focuses on preventing and decreasing swelling, managing pain, and pro- tecting the repair. The primary rehabilitation goals after surgi- cal treatment of elbow dislocation are restoring joint mobility while protecting the surgical repair, preserving elbow stability, and eventually restoring function. Increases in ROM should not be gained at the expense of joint stability. Restoring a func- tional arc of motion is essential to enabling the patient to return to normal activities. While normal elbow ROM has been mea- sured as 0 ° to 140 ° of flexion and extension, and supination/ pronation 80 ° to 85 ° , the functional ROM to complete most activities of daily living (ADLs) has been established as 30 ° to 130 ° (flexion/extension) and 50 ° /50 ° supination/pronation, although some common tasks may require higher degrees of flexion and forearm rotation. It is important to educate the

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© 2018 American Academy of Orthopaedic Surgeons

Postoperative Orthopaedic Rehabilitation