(Kiosk 2) Post-operative Rehabilitation Outcomes After an Elbow Dislocation and Displaced Fracture with Complications: A Case Report

Case Diagnosis: Post-operative elbow open reduction and internal fixation (ORIF) after an elbow dislocation and displaced fracture.

Case Description or Program Description: A 47-year-old male was referred to rehabilitation after ORIF due to skateboard fall. The patient started rehabilitation at 9 weeks after surgery, presenting significant loss of range of motion (ROM) at the elbow and wrist. A progressive rehabilitation approach was used that focused on improving ROM and function. Due to hardware protrusion laterally and significant elbow stiffness, hardware removal and manipulation under anesthesia were performed 4 weeks after initiation of rehabilitation. This resulted in a fractured distal humeral shaft, and a subsequent ORIF for this, followed with significant swelling, fracture blistering, and greater loss of function of the upper extremity. The patient resumed rehabilitation after the second ORIF to focus on decreasing the swelling and improving ROM and function.

Setting: Outpatient musculoskeletal rehabilitation

Assessment/Results: Outcome scores on ROM, Numerical Pain Rating Scale (NPRS) and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire were reported at initial evaluation and at discharge (7 months after initiated treatment). Functional ROM was achieved changing from 75o to 120o of elbow flexion, -40 o to 0 of elbow extension, and -60 o to 60o of forearm supination from initial evaluation to discharge. DASH scores changed from 94.16 to 19.16 (0-100) and NPRS scores changed from 8 to 4 points (0-10) from initial evaluation to discharge. Based on previously reported minimal clinically important difference (MCID) of 10.2 points for DASH and 1.7 points for NPRS for adults with musculoskeletal upper extremity problems undergoing surgery, the outcome measures improvements were clinically meaningful.

Discussion (relevance): ORIF is the surgical treatment for elbow displaced fracture. Although rare, complications may occur including infections, bleeding, nerve damage, joint stiffness, joint instability, and bone misalignment. Delay in rehabilitation and complications, such as joint stiffness and bone misalignment, may impact outcomes after elbow ORIF.

Conclusions: Despite the delay in starting rehabilitation and subsequent complications, the patient achieved a stable, and functional elbow. Early rehabilitation post operatively may be recommended when treating elbow fracture to allow return to function safely, to avoid complications, such as elbow stiffness, and prolonged rehabilitation.