Coronoid Fracture ORIF Protocol

An open reduction and internal fixation (ORIF) of a coronoid fracture is performed to restore stability to the elbow joint. The coronoid process of the ulna acts as a critical anterior and posterior stabilizer. The primary focus of this rehabilitation protocol is to protect the healing bone and surgical fixation while initiating early controlled range of motion to prevent elbow stiffness, which is highly common. Progression is criterion-based and relies on soft-tissue healing and surgeon-specific recommendations.

Phase I: Protection & Early Motion (Weeks 0-2)

• Goals:
  • Protect the healing coronoid bone and surgical fixation
  • Minimize post-operative pain, swelling, and inflammation
  • Maintain active range of motion (AROM) of the fingers, wrist, and shoulder
  • Initiate gentle, controlled elbow motion within safe limits
• Precautions & Restrictions:
  • Splint/Brace: Hinged elbow brace worn at all times (including during sleep), except during physical therapy exercises. The brace is typically locked at 90 degrees of flexion for the first 1-2 weeks.
  • Lifting: Strictly non-weight-bearing (restricted to light items under 1 lb, such as holding a cup).
  • Active Extension Prohibited: Avoid active elbow extension to protect the anterior joint capsule and brachialis muscle insertion on the coronoid. Extension should be performed passively or active-assisted.
  • Instability Protection: Avoid terminal elbow extension (extension is typically blocked at 30 degrees of flexion unless cleared by the surgeon). Perform forearm rotation only with the elbow bent to 90 degrees.
• Suggested Exercises:
  • Active range of motion (AROM) for fingers, wrist, and hand to prevent stiffness and manage swelling
  • Grip strengthening exercises (soft ball squeeze, putty)
  • Passive and active-assisted elbow flexion and extension within brace limits (flexion to 120 degrees, extension blocked at 30 degrees)
  • Forearm pronation and supination exercises performed strictly at 90 degrees of elbow flexion
  • Active shoulder range of motion (flexion, abduction, rotation) in a non-weight-bearing manner
• Criteria to Progress:
  • Minimal pain and swelling, with a healed incision
  • Passive elbow flexion to at least 110 degrees, and extension within 30 degrees of full
  • Full compliance with brace guidelines and safety precautions

Phase II: Progressive Active Range of Motion & Early Strengthening (Weeks 2-6)

• Goals:
  • Gradually restore full or near-full active range of motion of the elbow and forearm
  • Transition from active-assisted to full active elbow range of motion
  • Initiate light isometric strengthening of the elbow and forearm muscles
  • Maintain shoulder, rotator cuff, and scapular strength
• Precautions & Restrictions:
  • Splint/Brace: Hinged brace remains unlocked during activities and sleep, and may be discontinued in controlled environments by week 4-6 as directed.
  • Lifting: Gradually progress lifting from 1 lb up to a maximum of 5 lbs by week 6.
  • Resisted Loading: Avoid forceful resisted elbow flexion or extension exercises against gravity.
• Suggested Exercises:
  • Active-assisted and active elbow flexion and extension exercises, progressing toward full range
  • Active forearm pronation and supination stretching and mobility exercises
  • Gentle isometric elbow flexion, extension, pronation, and supination (submaximal effort)
  • Rotator cuff and scapular stabilization exercises (rows, Y/T/W exercises, and band external/internal rotation)
  • Wrist and grip strengthening exercises with light resistance (1-2 lbs)
• Criteria to Progress:
  • Full or near-full active range of motion of the elbow (extension/flexion and pronation/supination)
  • No joint instability or significant pain during exercises
  • Minimum of 6 weeks post-surgery

Phase III: Progressive Resistance & Functional Strengthening (Weeks 6-12)

• Goals:
  • Restore complete active range of motion in all planes, addressing residual stiffness
  • Introduce dynamic strengthening for the elbow, forearm, and shoulder
  • Return to normal activities of daily living (ADLs) and light work duties
• Precautions & Restrictions:
  • Splint/Brace: Discontinue brace completely at week 6 (unless otherwise directed by the surgeon).
  • Lifting: Progress lifting limits slowly from 5 lbs up to 15 lbs by week 12.
  • High-Impact Loading: Avoid closed-chain weight-bearing exercises (such as push-ups or planks) or sudden impact loads.
• Suggested Exercises:
  • End-range passive stretching and joint mobilization if joint stiffness is present
  • Progressive resistance exercises (PREs) for elbow flexion and extension (biceps curls, triceps push-downs) using light dumbbells or bands
  • Forearm strengthening (wrist curls, pronation/supination using a hammer or weighted rod)
  • Progressive shoulder and scapular strengthening with increased resistance
  • Light functional training tasks
• Criteria to Progress:
  • Full, pain-free active elbow range of motion
  • Elbow and forearm strength at least 80% compared to the contralateral side
  • Bony healing confirmed on follow-up X-rays

Phase IV: Advanced Conditioning & Return to Activity (Weeks 12+)

• Goals:
  • Restore full upper extremity strength, power, and muscular endurance
  • Return to sports, heavy manual labor, or unrestricted overhead activities
  • Prevent future injury through proper biomechanics and conditioning
• Precautions & Restrictions:
  • Gradual return to unrestricted sports or physical labor under surgeon guidance
  • Monitor for any recurrent joint pain or swelling
• Suggested Exercises:
  • Dynamic and eccentric strengthening of the elbow flexors and extensors
  • Full closed-chain stabilization and weight-bearing exercises (push-ups, planks, bear crawls)
  • Upper extremity plyometrics and medicine ball drills
  • Sport-specific or work-specific drill progressions (throwing, racket swinging, tool use)
• Criteria for Return to Activity:
  • Surgeon clearance
  • Pain-free performance of all sports- or work-related movements
  • Upper extremity strength >90% compared to the uninjured side

These guidelines represent a standard rehabilitation protocol. Individual recovery rates vary significantly depending on the size of the repair, bone/tissue quality, and general patient health. Your surgeon may modify this protocol specifically for you.

Disclaimer: This protocol is for educational purposes and is not a substitute for professional medical advice. Always consult your surgeon or physical therapist before performing any exercises or modifying activity restrictions.