IJCM  Vol.5 No.9 , April 2014
Rehabilitation Including Manual Therapy Management Following Complicated Immobilized Radial Head Fracture and Elbow Stiffness: A Case Report
ABSTRACT

Radial head fractures are one of the most common fractures of the elbow and typically occur after a fall on an outstretched arm. When the fracture is displaced, unfavorable outcomes can occur and lead to early arthritis. Additionally, elbow pain and stiffness due to immobilization or surgical reduction and stabilization typically ensues and can limit one’s overall upper extremity function. Rehabilitation following such a fracture can be challenging and the inclusion of manual therapy in the management process has not been described to date in the literature. Therefore, the aim of this case report is to present the evaluation and treatment of a 40-year-old female following a complicated radial head fracture. The rehabilitation conducted over a four-month course is discussed and the benefits of joint specific manual therapy in the rehabilitation are highlighted.


Cite this paper
Stump, M. , Sizer, P. and Brismée, J. (2014) Rehabilitation Including Manual Therapy Management Following Complicated Immobilized Radial Head Fracture and Elbow Stiffness: A Case Report. International Journal of Clinical Medicine, 5, 498-506. doi: 10.4236/ijcm.2014.59069.
References
[1]   Bano, K.Y. and Kahlon, R.S. (2006) Radial Head Fractures—Advanced Techniques in Surgical Management and Rehabilitation. Journal of Hand Therapy, 19, 114-136. http://dx.doi.org/10.1197/j.jht.2006.02.011

[2]   Liow, R.Y.L., Cregan, A., Nanda, R. and Montgomery, R.J. (2002) Early Mobilisation for Minimally Displaced Radial Head Fractures Is Desirable: A Prospective Randomised Study of Two Protocols. Injury, 33, 801-806.
http://dx.doi.org/10.1016/S0020-1383(02)00164-X

[3]   Paschos, N.K., Mitsionis, G.I., Vasiliadis, H.S. and Georgoulis, A.D (2013) Comparison of Early Mobilization Protocols in Radial Head Fractures. Journal of Orthopaedic Trauma, 27, 134-139.
http://dx.doi.org/10.1097/BOT.0b013e31825cf765

[4]   Pike, J.M., Athwal, G.S., Faber, K.J. and King, G.J.W. (2009) Radial Head Fractures—An Update. The Journal of Hand Surgery, 34, 557-565. http://dx.doi.org/10.1016/j.jhsa.2008.12.024

[5]   Herbertsson, P., Josefsson, P.-O., Hasserius, R., Karlsson, C., Besjakov, J. and Karlsson, M. (2004) Uncomplicated Mason Type-II and III Fractures of the Radial Head and Neck in Adults: A Long-Term Follow-Up Study. The Journal of Bone & Joint Surgery, 86, 569-574.

[6]   Harding, P., Rasekaba, T., Smirneos, L., and Holland, A.E. (2011) Early Mobilisation for Elbow Fractures in Adults. In: The Cochrane Collaboration and P. Harding, Eds., Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd., Chichester.

[7]   Koh, K.H., Lim, T.K., Lee, H.I. and Park, M.J. (2013) Surgical Release of Elbow Stiffness after Internal Fixation of Intercondylar Fracture of the Distal Humerus. Journal of Shoulder and Elbow Surgery, 22, 268-274.
http://dx.doi.org/10.1016/j.jse.2012.10.024

[8]   Søjbjerg, J.O. (1996) The Stiff Elbow. Acta Orthopaedica Scandinavica, 67, 626-631.
http://dx.doi.org/10.3109/17453679608997771

[9]   Lindenhovius, A.L.C., Doornberg, J.N., Brouwer, K.M., Jupiter, J.B., Mudgal, C.S. and Ring, D. (2012) A Prospective Randomized Controlled Trial of Dynamic versus Static Progressive Elbow Splinting for Posttraumatic Elbow Stiffness. The Journal of Bone & Joint Surgery, 94, 94-700.

[10]   King, G.J.W. and Faber, K.J. (2000) Post Traumatic Elbow Stiffness. Orthopedic Clinics of North America, 31, 129-143. http://dx.doi.org/10.1016/S0030-5898(05)70133-4

[11]   Doornberg, J.N., Ring, D. and Jupiter, J.B. (2006) Static Progressive Splinting for Posttraumatic Elbow Stiffness. Journal of Orthopaedic Trauma, 20, 400-404. http://dx.doi.org/10.1097/00005131-200607000-00006

[12]   Keschner, M.T. and Paksima, N. (2007) The Stiff Elbow. Bulletin of the NYU Hospital for Joint Diseases, 65, 24-28.

[13]   Issack, P.S. and Egol, K.A. (2006) Posttraumatic Contracture of the Elbow: Current Management Issues. Bulletin of the NYU Hospital for Joint Diseases, 63, 129-136.

[14]   Gelinas, J.J., Faber, K.J., Patterson, S.D. and King, G.J.W. (2000) The Effectiveness of Turnbuckle Splinting for Elbow Contractures. The Journal of Bone & Joint Surgery, 82-B, 74-78. http://dx.doi.org/10.1302/0301-620X.82B1.9792

[15]   Mathew, P.K., Athwal, G.S. and King, G.J. (2009) Terrible Triad Injury of the Elbow: Current Concepts. Journal of the American Academy of Orthopaedic Surgeons, 17, 137-151.

[16]   Winkel, D., Matthijis, O. and Phelps, V. (1997) Diagnosis and Treatment of the Upper Extremities: Nonoperative Orthopaedic Medicine and Manual Therapy. Aspen, Gaithersburg.

[17]   Taylor, D.C., Dalton Jr., J.D., Seaber, A.V. and Garrett Jr., W.E. (1990) Viscoelastic Properties of Muscle-Tendon Units. The biomechanical effects of stretching. The American Journal of Sports Medicine, 18, 300-309.
http://dx.doi.org/10.1177/036354659001800314

[18]   Dutton, M. (2004) The Response of Biological Tissue to Stress. In: Brown, M. and Davis, K., Eds., Orthopaedic Examination, Evaluation, and Intervention, McGraw-Hill, New York, 87-100.

[19]   Ehsan, A., Huang, J.I., Lyons, M. and Hanel, D.P. (2012) Surgical Management of Posttraumatic Elbow Arthrofibrosis. Journal of Trauma and Acute Care Surgery, 72, 1399-1403.

[20]   Weizenbluth, M., Eichenblat, M., Lipskeir, E. and Kessler, I. (1989) Arthrolysis of the Elbow. 13 Cases of Posttraumatic Stiffness. Acta Orthopaedica Scandinavica, 60, 642-645.
http://dx.doi.org/10.3109/17453678909149594

[21]   Bruno, R.J., Lee, M.L., Strauch, R.J. and Rosenwasser, M.P. (2002) Posttraumatic Elbow Stiffness: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons, 10, 106-116.

[22]   Marti, R., Kerkhoffs, G., Maas, M. and Blankevoort, L. (2002) Progressive Surgical Release of a Posttraumatic Stiff Elbow: Technique and Outcome after 2-18 Years in 46 Patients. Acta Orthopaedica, 73, 144-150.
http://dx.doi.org/10.1080/000164702753671713

[23]   Jupiter, J.B., O’Driscoll, S.W. and Cohen, M.S. (2003) The Assessment and Management of the Stiff Elbow. Instructional Course Lectures, 52, 93-111.

[24]   Charalambous, C.P. and Morrey, B.F. (2012) Posttraumatic Elbow Stiffness. The Journal of Bone & Joint Surgery, 94, 1428-1437.http://dx.doi.org/10.2106/JBJS.K.00711

 
 
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