Distal Humerus Fracture ORIF Protocol

Open Reduction and Internal Fixation (ORIF) of a distal humerus fracture is a surgical procedure performed to realign and secure broken bone fragments at the lower end of the upper arm bone using plates and screws. Because the elbow joint is highly prone to stiffness, the primary rehabilitation philosophy centers on balancing stable bone healing with early, controlled range of motion to prevent joint contractures.

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

Goals:

• Protect the surgical fixation and promote early wound healing.
• Control post-operative pain and swelling (edema).
• Initiate gentle, controlled elbow and forearm movement as tolerated.
• Maintain full active motion of the shoulder, wrist, and hand.

Precautions & Restrictions:

• Wear the protective splint or posterior mold at all times except during exercises or hygiene (as instructed by your surgeon).
• No lifting, carrying, pushing, or pulling with the operated arm.
• Avoid passive stretching or forcing terminal range of motion.
• No weight bearing through the operated upper extremity.

Suggested Exercises:

• Active and passive hand, wrist, and shoulder exercises (e.g., finger curls, wrist extension/flexion, shoulder shrugs, pendulum exercises).
• Active-assisted range of motion (AAROM) for elbow flexion and extension in a pain-free arc.
• Active forearm pronation and supination (rotating palm up and down) with the elbow supported at 90 degrees of flexion.
• Ice, elevation, and retrograde massage for swelling control.

Criteria to Progress:

• Healed surgical incisions with no signs of infection.
• Well-controlled pain and swelling.
• Completion of 2 weeks post-surgery.

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

Goals:

• Transition from active-assisted to full active range of motion (AROM) of the elbow and forearm.
• Minimize muscle atrophy without placing undue stress on the healing bone.
• Encourage light daily activities (e.g., eating, dressing) within safety limits.

Precautions & Restrictions:

• Continue wearing a removable splint or hinged elbow brace (if prescribed) between exercise sessions.
• No lifting objects heavier than a cup of water (approx. 1 pound).
• Avoid passive stretching or pushing the elbow to the point of sharp pain.
• No resistance training or weight bearing.

Suggested Exercises:

• Progress from AAROM to active range of motion (AROM) for elbow flexion, extension, pronation, and supination.
• Gentle isometric exercises for the wrist, hand, and shoulder (no resistance at the elbow).
• Postural education and scapular retraction exercises.
• Continued hand gripping exercises to maintain grip strength and reduce swelling.

Criteria to Progress:

• Near-full or progressive active elbow flexion/extension and forearm rotation.
• Stable radiographic signs of bone healing (confirmed by surgeon).
• Completion of 6 weeks post-surgery.

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

Goals:

• Achieve full, unrestricted active and passive range of motion.
• Begin progressive strengthening of the elbow, forearm, and upper extremity.
• Restore normal functional use of the arm for basic daily living tasks.

Precautions & Restrictions:

• No sudden lifting or carrying of objects heavier than 5-10 pounds.
• No heavy manual labor, contact sports, or sudden impact activities.
• Stretching should be progressive and steady, avoiding high-velocity or ballistic movements.

Suggested Exercises:

• Gentle passive range of motion (PROM) and low-load, long-duration stretching to address terminal extension or flexion deficits.
• Progressive resistance exercises (PRE) using light weights or resistance bands for elbow flexion/extension and forearm pronation/supination.
• Comprehensive upper extremity strengthening, including shoulder rotator cuff, scapular stabilizers, and wrist flexors/extensors.
• Single-arm functional tasks to promote coordination.

Criteria to Progress:

• Full active and passive elbow range of motion (or plateaued at a functional level).
• Pain-free execution of light strengthening exercises.
• Radiological evidence of solid bone union.

Phase IV: Advanced Conditioning & Return to Activity (Weeks 12 - 24+)

Goals:

• Restore maximal strength, endurance, and power of the upper limb.
• Transition back to work-specific duties, sports, and recreational activities.
• Prevent re-injury through proper biomechanics and conditioning.

Precautions & Restrictions:

• Gradual return to heavy lifting or high-impact activities under medical guidance.
• Modify activities if pain or joint irritation occurs.

Suggested Exercises:

• Advanced progressive strengthening (free weights, cable machines, bodyweight exercises).
• Sport-specific or work-specific functional conditioning drills.
• Dynamic stabilization and plyometric training for patients returning to sports.
• Continued flexibility program to maintain full joint mobility.

Criteria to Progress:

• Clear check-out from surgeon for unrestricted activity.
• Normal strength (at least 85-90% compared to the uninjured side).
• Complete bone consolidation on radiographs.

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.