Radial Head/Neck Fracture ORIF Protocol

This rehabilitation protocol is designed to guide patients and physical therapists through recovery following open reduction and internal fixation (ORIF) of a radial head or neck fracture. Because the elbow joint is highly prone to stiffness, the primary philosophy of this protocol is to initiate early, controlled motion while protecting the healing bone and surgical hardware.

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

The focus during the first two weeks is on wound healing, controlling post-surgical swelling, and starting gentle movement within safe limits to prevent stiffness.

• Goals: Control pain and swelling; protect the surgical fixation; promote incision healing; initiate gentle, controlled active-assisted elbow and forearm motion.
• Precautions & Restrictions: Strict non-weight-bearing on the affected arm (do not lift, push, pull, or carry anything); wear the removable splint or hinge brace as instructed, removing it only for hygiene and designated exercises; avoid aggressive passive stretching.
• Suggested Exercises: Active-assisted range of motion (AAROM) for elbow flexion and extension in a comfortable range; gentle active pronation and supination with the elbow bent to 90 degrees; active hand, wrist, and shoulder exercises to prevent secondary stiffness; swelling reduction techniques such as arm elevation and hand squeezing.
• Criteria to Progress: Well-healed surgical incision; controlled pain and swelling; adherence to activity restrictions.

Phase 2: Active Motion & Healing (Weeks 2-6)

During this phase, bone healing is underway, and the focus shifts to recovering full active range of motion without resistance.

• Goals: Restore full or near-full active range of motion (AROM) in all directions; minimize swelling and scar tissue adhesion; gradually wean off the brace as directed by your surgeon (typically by week 4-6).
• Precautions & Restrictions: Do not lift objects heavier than 1-2 pounds; no resisted elbow or forearm exercises; avoid sudden movements, pushing off chairs, or weight-bearing through the arm.
• Suggested Exercises: Active elbow flexion, extension, pronation, and supination; gentle, prolonged passive stretching at the end of range of motion if stiffness persists (do not force or bounce); scar mobilization once the incision is fully closed and scab-free; proprioceptive and coordination exercises.
• Criteria to Progress: Minimal to no pain with active movements; active elbow range of motion near normal limits (flexion to at least 130 degrees, extension within 10 degrees of straight).

Phase 3: Progressive Strengthening (Weeks 6-12)

With stable bone healing confirmed, resistance exercises are introduced to rebuild muscle strength and functional capacity.

• Goals: Rebuild strength and endurance of the elbow, forearm, wrist, and shoulder muscles; restore full functional use of the arm for everyday activities; maintain full range of motion.
• Precautions & Restrictions: Avoid sudden, heavy lifting or contact sports; progress resistance levels slowly and pain-freely.
• Suggested Exercises: Light strengthening exercises using resistance bands or light dumbbells (starting at 1-2 lbs) for elbow flexion/extension and forearm rotation; wrist strengthening (curls and reverse curls); shoulder and scapular stabilization exercises; progressive functional training (e.g., reaching, lifting light household objects).
• Criteria to Progress: Full, pain-free active range of motion; progressive strength improvement (at least 4/5 on manual muscle testing) without pain.

Phase 4: Advanced Strengthening & Return to Activity (Weeks 12-18+)

The final phase focuses on high-level conditioning and a safe return to sports, work, and unrestricted physical activities.

• Goals: Restore full muscle strength, power, and muscular endurance; safely transition back to demanding work tasks, sports, and recreational activities.
• Precautions & Restrictions: Resumption of heavy lifting, contact sports, or high-impact activities must be gradual and cleared by your surgeon.
• Suggested Exercises: Progressive resisted strengthening (eccentric and concentric); sport-specific or work-specific training drills; advanced plyometric exercises (if returning to sports); continued stretching and mobility maintenance.
• Criteria to Progress: Pain-free return to full, unrestricted activity; normal strength and endurance compared to the opposite arm; complete patient confidence in elbow function.

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.