Olecranon Fracture ORIF Protocol

An olecranon fracture is a break of the bony prompt of the elbow (the olecranon process of the ulna). Open Reduction and Internal Fixation (ORIF) surgery utilizes plates, screws, or tension-band wiring to anatomically align and rigidly stabilize the bone. This rigid fixation allows for early range of motion, which is essential to prevent elbow stiffness (arthrofibrosis). The rehabilitation program balances protecting the healing bone and triceps tendon insertion with progressive mobilization to optimize joint function.

Phase 1: Early Protection & Motion (Weeks 0 - 2)

Goals:

• Protect surgical incision and stable hardware fixation.
• Control pain, swelling (edema), and inflammation.
• Initiate early, gentle elbow range of motion to prevent stiffness.
• Maintain full active range of motion of the shoulder, wrist, and hand.

Precautions & Restrictions:

• Wear the postoperative splint or sling at all times, removing it only for hygiene and designated exercises.
• No active elbow extension (against gravity or resistance) to protect the triceps tendon insertion at the olecranon.
• No lifting or weight bearing on the affected arm.
• Avoid sudden or jerky arm movements.
• No soaking the wound in water (bath or pool); keep incision dry.

Suggested Exercises:

• Passive and active-assisted elbow flexion and extension (within comfortable, pain-free limits).
• Active forearm pronation and supination (with elbow bent at 90 degrees).
• Active shoulder range of motion (flexion, abduction, rotation) to prevent shoulder stiffness.
• Active wrist and hand range of motion (fingers, wrist flexion/extension).
• Grip strengthening using a soft ball or putty.

Criteria to Progress:

• Well-healed incision without signs of infection.
• Controlled pain and edema.
• Minimum elbow motion of 30 to 100 degrees of flexion/extension.
• Compliance with postoperative restrictions.

Phase 2: Progressive Range of Motion & Soft Tissue Mobilization (Weeks 2 - 6)

Goals:

• Gradually restore full passive and active-assisted range of motion (PROM/AAROM).
• Begin gentle active range of motion (AROM) of the elbow.
• Prevent adhesion of the triceps tendon and mobilize scar tissue once healed.
• Continue to manage residual swelling and maintain distal joint mobility.

Precautions & Restrictions:

• Discontinue the sling/splint during the day under therapist guidance, but may continue to wear it in public or for sleep for protection.
• No loaded active elbow extension against gravity or resistance.
• No lifting objects heavier than a coffee cup (approx. 1 lb) with the surgical arm.
• Do not force terminal extension or flexion if there is severe pain or resistance.

Suggested Exercises:

• Progression from active-assisted to active elbow flexion and extension (in gravity-minimized positions).
• Continuous forearm rotation (pronation and supination) stretching.
• Soft tissue mobilization around the incision and triceps insertion to prevent scar tissue restriction.
• Light isometric elbow flexion and wrist/forearm exercises (no triceps loading).
• Gentle passive elbow extension stretching (letting gravity assist).

Criteria to Progress:

• Elbow flexion/extension of at least 15 to 120 degrees.
• Forearm pronation and supination within 80% of the unaffected side.
• Bone healing showing early stability on follow-up X-rays (usually at 6 weeks).
• Minimal pain during active motion.

Phase 3: Active Range of Motion & Early Strengthening (Weeks 6 - 12)

Goals:

• Achieve full, unrestricted range of motion in elbow flexion/extension and forearm rotation.
• Initiate gentle, progressive active strengthening for all elbow and forearm musculature.
• Gradually load the triceps tendon as bone healing progresses.
• Restore normal upper extremity movement patterns.

Precautions & Restrictions:

• No sudden lifting, heavy resistance, or contact sports.
• Avoid high-impact loading or weight-bearing (e.g., push-ups, planks).
• Discontinue all protective splints/slings.

Suggested Exercises:

• Active elbow extension against gravity, progressing to light resistance (e.g., yellow Theraband, light weights starting at 1 to 2 lbs).
• Progressive resistance exercises (PRE) for elbow flexion (biceps), forearm rotation, and wrist flexors/extensors.
• Eccentric triceps strengthening (light loading).
• Proprioceptive exercises for joint position sense.
• Closed-chain weight-bearing exercises through the hand with light loading (e.g., wall push-ups).

Criteria to Progress:

• Full or near-full active range of motion of the elbow and forearm.
• Radiographic evidence of stable bony union.
• No tenderness over the fracture site or hardware.
• Normal daily activity performance without pain.

Phase 4: Advanced Strengthening & Return to Activity (Weeks 12+)

Goals:

• Restore maximum strength, power, and endurance of the upper extremity.
• Achieve full functional and recreational return to activity, work, or sports.
• Implement sport-specific or work-specific rehabilitation drills.

Precautions & Restrictions:

• None, unless specified by the surgeon due to delayed bone union or hardware discomfort.
• Note: Some patients may feel prominent hardware (plates/wires) under the skin. If symptomatic, discuss hardware removal with the surgeon once the fracture is fully healed (usually after 9 to 12 months).

Suggested Exercises:

• Progressive upper body weightlifting (e.g., push-ups, shoulder press, pull-downs).
• High-velocity and plyometric exercises for athletes (e.g., medicine ball throws).
• Advanced triceps and core strengthening.
• Sport-specific training (e.g., throwing programs, racket swings).

Criteria to Progress:

• Full return to pre-injury activity levels.
• Upper extremity strength at least 90% of the uninjured side.
• Complete, pain-free performance of occupational or athletic demands.

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.