Is vigorous physiotherapy contraindicated after elbow fracture?

April 24, 2007

May 17, 2007

Matt Shrimpton, Ellie Douse, Physiotherapists (Manchester Royal Infirmary)

Michael Callaghan, Manchester Royal Infirmary

In [young adults post elbow ORIF] will [vigorous physiotherapy] increase [heterotopic ossification]

A 17 year old female has had her elbow reconstructed after a compound, comminuted fracture resulting from an RTA. Although the anatomical reconstruction is excellent, she is left with severe restriction of her elbow RoM. Although you are keen to improve her RoM and function, colleagues are cautioning against vigorous physiotherapy as they fear the patient may develop heterotopic ossification. You wonder if there is any real evidence for these fears.

MEDLINE 1966 – 02/07, CINAHL 1982 – 02/07, AMED 1985 – 02/07, SPORTDiscus 1830 – 02/07, EMBASE 1996 – 02/07, via the OVID interface. In addition to the Cochrane database and PEDro database were also searched.

Medline, CINAHL, AMED, SPORTDiscus, EMBASE, Cochrane database for systematic reviews, PEDro: (ossification) AND (physical therapy techniques) AND (exercise) AND (physiotherapy) AND (physical therapy techniques OR exercise OR physiotherapy) AND (elbow) AND (ossification AND (physical therapy techniques OR exercise OR physiotherapy) AND elbow). LIMITS human AND English Language.

No papers were found specific to the clinical scenario.

In the absence of any relevant evidence it is not possible to determine whether vigorous physiotherapy in young adults following elbow ORIF will increase the occurrence of heterotropic ossification.