Recovery Challenges After Mason Type III Radial Head Fracture

Limited flexion and extension after a Mason type III fracture of the radial head?

Hello Doctor, I had surgery on November 26, where a steel plate and four screws were used to stabilize and fix the radius neck.
The physician advised that I should have the stitches removed after two weeks and begin passive flexion and extension exercises, followed by passive forearm rotation and active flexion and extension exercises after four weeks.
Currently, I can fully extend my arm, but I can only flex it to about 80 degrees, and there has been no significant improvement since starting two weeks ago.
I can rotate my forearm from the supinated position to the neutral position, but I hesitate to rotate it an additional 10 degrees.
During my rehabilitation process, I have the following questions:
1.
How can I reduce the swelling? I apply heat before performing flexion and extension exercises; will this affect the swelling reduction? Will active flexion and extension exercises impact the swelling?
2.
Could this be heterotopic ossification?
3.
What could be the cause of the swelling? Is it related to my sleeping position with my arm in a 90-degree flexed position on a splint?
4.
Currently, I am active at home about four times a day: applying heat for 15 minutes, then performing 10 active flexion and extension repetitions, holding each to the limit for 10 seconds, followed by 10 passive forearm rotations to the neutral position, holding for 10 seconds, and actively moving my wrist.
I also flex and extend my elbow occasionally to prevent stiffness from inactivity.

Doctor, can I increase the frequency of these activities? Thank you very much for your response; your guidance helps me live more courageously!

A-Chang, 20~29 year old female. Ask Date: 2014/12/23

Dr. Shi Guozheng reply Orthopedics

After surgery for a radial head fracture at the elbow joint, it typically takes about six to twelve weeks for the swelling to completely subside.
Your description does not indicate any infection issues, but rather poor mobility, which can be improved through active rehabilitation.
Heterotopic ossification generally occurs in more comminuted elbow fractures.
Rehabilitation exercises and repetitions should be performed according to one's capability and should be done gradually without rushing.

Reply Date: 2014/12/23

More Info

Recovering from a Mason Type III radial head fracture can be a challenging process, particularly when it comes to regaining full range of motion and strength in the affected arm. Your situation, as described, indicates that you are on the right track with your rehabilitation, but there are several factors to consider regarding your recovery and the issues you are experiencing.

Firstly, it’s important to understand that swelling after surgery is a common occurrence. The fact that you are experiencing some residual swelling near the triceps area, even after two weeks, is not unusual. This could be due to several reasons, including inflammation from the surgical procedure itself, the body’s natural healing response, or even the positioning of your arm during rest and sleep.
1. Managing Swelling: To help reduce the swelling, you can continue with the application of ice packs rather than heat. While heat can be soothing and may help with muscle relaxation, it can also increase blood flow to the area, potentially exacerbating swelling. Ice should be applied for about 15-20 minutes at a time, several times a day, especially after any activity that may cause swelling to increase. Elevating your arm above heart level can also assist in reducing swelling.

2. Concerns about Heterotopic Ossification: Heterotopic ossification (HO) is a condition where bone tissue forms outside of the skeleton, often in soft tissues. While it can occur after trauma or surgery, it typically presents with significant pain and restricted motion, which does not seem to be your primary issue at this point. However, if you notice increased pain, stiffness, or a decrease in range of motion, it would be wise to consult your physician for further evaluation.

3. Potential Causes of Swelling: The swelling you are experiencing could be attributed to several factors, including the surgical trauma, the immobilization of the joint, or even the positioning of your arm during sleep. Keeping your arm in a flexed position for prolonged periods can lead to increased pressure and swelling in the area. It might be beneficial to adjust your sleeping position to ensure your arm is not excessively bent.

4. Rehabilitation Protocol: Your current rehabilitation routine seems well-structured, focusing on both active and passive movements. It is crucial to listen to your body during this process. If you feel that you can increase the frequency of your exercises without causing pain or excessive fatigue, you may consider doing so. Gradually increasing the intensity and frequency of your exercises can help improve your range of motion and strength. However, be cautious not to overdo it, as this can lead to setbacks.

In terms of your recovery timeline, it’s essential to have realistic expectations. Full recovery from a Mason Type III fracture can take several months, and progress may not always be linear. It’s normal to experience fluctuations in your ability to perform certain movements, and patience is key. Regular follow-ups with your healthcare provider will help monitor your progress and adjust your rehabilitation plan as needed.

In conclusion, while you are experiencing some challenges with swelling and range of motion, these are common in the recovery process from a radial head fracture. By managing swelling effectively, maintaining a consistent rehabilitation routine, and communicating openly with your healthcare team, you can optimize your recovery and work towards regaining full function of your arm. Remember to celebrate small victories along the way, as each step forward is a significant achievement in your healing journey.

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