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Chapter 19 • Rehabilitation After ORIF of Elbow Dislocations

Chan K, King GJ, Faber KJ: Treatment of complex elbow fracture- dislocations. Curr Rev Musculoskelet Med 2016;9(2): 185–189. Davila S: Therapist’s management of fractures and dislocations of the elbow, In Skirven TM, Osterman AL, Fedorczyk JM, Amadio PC, eds. Rehabilitation of the Hand and Upper Extremity, ed 6. Philadelphia, PA, Elsevier, 2011. Doornberg JN, Ring DC: Fractures of the anteromedial facet of the coronoid process. J Bone Joint Surg Am 2006;88(10): 2216–2224. Heo YM, Yi JW, Lee JB, Lee DH, Park WK, Kim SJ: Unstable simple elbow dislocation treated with the repair of lateral collateral ligament complex. Clin Orthop Surg 2015;7(2): 241–247. Josefsson PO, Johnell O, Gentz CF: Long-term sequelae of sim- ple dislocation of the elbow. J Bone Joint Surg Am 1984;66: 927–930. Kaltenborn FM: Mobilisation of the Extremity Joints. Oslo, Norway, Olaf Norlis Bokhandel Universitetgaten, 1980. Lockard M: Clinical Biomechanics of the Elbow. Journal of Hand Therapy 2006;19(2):72–81. Maitland GD: Maitland’s Peripheral Manipulation, London, England, Butterworths, 1977. McKee MD, Schemitsch EH, Sala MJ, O’Driscoll SW: The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg 2003;12:391–396. McKee MD, Pugh DM, Wild LM, Schemitsch EH, King GJ: Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical technique. J Bone Joint Surg Am 2005;87(1):22–32. Morrey BF, An KN: Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res 1985;201:84–90. Morrey BF, Askew LJ, Chao EY: A biomechanical study of nor- mal functional elbow motion. J Bone Joint Surg Am 1981;63: 872–877. O’Driscoll SW, Bell DF, Morrey BF: Posterolateral rotatory insta- bility of the elbow. J Bone Joint Surg Am 1991;73:440–446. Richard MJ, Aldridhe JM 3rd, Wiesler ER, Ruch DS: Traumatic valgus instability of the elbow: pathoanatomy and results of direct repair. J Bone Joint Surg Am 2008;90(11):2416–2422. Ring D, Jupiter JB, Zilberfarb J: Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am 2002;84(4):547–551. Sardelli M, Tashjian RZ, MacWilliams BA: Functional elbow range of motion for contemporary tasks. J Bone Joint Surg Am 2011;93(5):471–477. Wolff AL, Hotchkiss RN: Lateral elbow instability: nonopera- tive, operative, and postoperative management. J Hand Ther 2006;19(2):238–243.

Figure 19.17  Photograph of the push/pull exercise.

●● Determining the stable ROM, including the position of the forearm, is essential to determining the early rehabilitation protocol. ●● The distracting weight of the forearm on the elbow can be negated by performing AA extension with the patient in the supine position. Summary Successful surgical treatment of traumatic elbow instability requires an understanding of the normal anatomy and the underlying instability pattern by both the surgeon and the ther- apist. The structures repaired must be protected as the elbow is being mobilized. Therefore, it is important to have open communication between the patient, therapist, and surgeon to achieve the desired goals. Bibliography An KN, Zobitz ME, Morrey BF: Biomechanics of the elbow, In Morrey BF, Sanchez-Sotelo J, eds. The Elbow and its Disor- ders, ed 4. Philadelphia, PA, Saunders, 2009, pp 39–63.

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Postoperative Orthopaedic Rehabilitation