Rehabilitation Challenges After Elbow Olecranon Fracture Surgery

Rehabilitation Issues After Comminuted Olecranon Fracture of the Elbow

On September 5th, my child suffered an injury from climbing a wall, resulting in a comminuted fracture of the left elbow.
Surgery was performed on the same day, and a metal plate was installed for stabilization.
The cast was removed on October 31st.
Rehabilitation began on November 4th, and the therapist at the hospital taught me how to perform exercises at home.
However, when I do rehabilitation exercises for the left arm at home, I often feel the metal plate and worry that it is only separated by a thin layer of skin, so I am hesitant to bend it too forcefully for fear of displacing the plate.
1.
"What should I be cautious about?" On November 11th, during the third follow-up rehabilitation session, I asked the therapist about this concern.
She mentioned that the range of motion in my left arm is still quite limited and advised against excessive self-rehabilitation at home until I improve further.
2.
Regarding rehabilitation, I have only completed the third session, but my family is considering transferring me to a closer hospital for rehabilitation due to the long travel distance (approximately half an hour by highway).
I believe that since I have just started rehabilitation, and my current therapist is more familiar with my condition, I would prefer not to switch hospitals.
3.
Is it advisable to transfer hospitals at this stage?

Yuning, 20~29 year old female. Ask Date: 2011/11/11

Dr. Li Wenlin reply Orthopedics

Hello, Yuning.

1.
The area around the olecranon of the elbow does not have thick muscle or soft tissue; beneath the skin is the bone.
Therefore, after a fracture is stabilized with pins and wires, it is indeed easy to feel a protrusion under the skin.
In principle, if there is no pain and it does not hinder elbow movement, there is no need for concern.
However, if there is pain, please inform your attending physician and seek their advice.
Displacement of the pins generally presents more noticeable symptoms (such as the skin being pushed up by the pin, or the pin breaking through the skin, or pain during elbow movement), so please do not worry.
2.
Regarding rehabilitation, it is likely that it can only be done in the same location.
If it is inconvenient, please try to listen to your attending physician's opinion.
If they agree, it would be better to transfer to another location for rehabilitation.
Wishing you all the best!
Li Wenlin

Reply Date: 2011/11/11

More Info

Rehabilitation after an elbow olecranon fracture surgery can be a challenging process, particularly when dealing with the psychological and physical aspects of recovery. The olecranon, which is the bony prominence of the elbow, is crucial for arm movement and stability. Given your situation, where you experienced a comminuted fracture and had surgical intervention with the insertion of metal hardware, there are several factors to consider as you navigate your rehabilitation journey.

1. Understanding Your Limitations
After surgery, it is common to feel apprehensive about moving the affected limb, especially when you can feel the hardware beneath the skin. This sensation can lead to a fear of causing further injury or displacing the hardware, which is often referred to as "hardware migration." It is essential to communicate these feelings with your physical therapist and orthopedic surgeon. They can provide reassurance and guidance on safe movements that will not jeopardize your recovery.

2. Importance of Gradual Progression
Your therapist's advice to avoid excessive self-directed rehabilitation at this stage is prudent. Early rehabilitation should focus on gentle range-of-motion exercises to prevent stiffness while avoiding any aggressive movements that could stress the surgical site. It is crucial to follow a structured rehabilitation program that gradually increases in intensity as your healing progresses. Typically, the first few weeks post-surgery are about regaining mobility without overexerting the joint.

3. Transitioning to a New Rehabilitation Facility
Regarding your concern about transferring to a closer rehabilitation facility, there are pros and cons to consider. On one hand, continuity of care is vital, especially in the early stages of rehabilitation. Your current therapist is familiar with your specific needs and recovery goals, which can lead to more personalized care. On the other hand, if the distance to your current facility is a significant barrier to consistent therapy sessions, it may be worth exploring local options.

If you decide to switch facilities, ensure that the new therapist is well-informed about your medical history, surgical details, and rehabilitation progress. A thorough handoff can help maintain the continuity of your care. It may also be beneficial to have a session with both therapists to discuss your rehabilitation plan and ensure that everyone is on the same page.

4. Monitoring Pain and Function
As you progress through rehabilitation, pay close attention to your pain levels and functional abilities. It is normal to experience some discomfort as you begin to move your elbow, but sharp or severe pain could indicate that you are pushing too hard. Keep a journal of your pain levels and any difficulties you encounter during exercises, and share this information with your therapist. They can adjust your rehabilitation program accordingly.

5. Long-Term Considerations
Finally, keep in mind that recovery from an olecranon fracture can take time, and patience is key. Full range of motion may not be achievable immediately, and it is essential to set realistic goals. Regular follow-ups with your orthopedic surgeon will help monitor your healing process and determine when it is safe to advance your rehabilitation.

In summary, focus on gradual progression in your rehabilitation, maintain open communication with your healthcare providers, and consider the implications of transferring facilities carefully. With the right approach and support, you can work towards regaining full function of your elbow and returning to your daily activities.

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