Is vigorous physiotherapy contraindicated after elbow fracture?

Report By: Matt Shrimpton, Ellie Douse - Physiotherapists
Search checked by Michael Callaghan - Research Physiotherapist
Institution: Manchester Royal Infirmary
Date Submitted: 24th April 2007
Last Modified: 17th May 2007
Status: Blue (submitted but not checked)

Three Part Question

In [young adults post elbow ORIF] will [vigorous physiotherapy] increase [heterotopic ossification]

Clinical Scenario

A 17 year old female has had her elbow reconstructed after a compound, comminuted fracture resulting from an RTA. Although the anatomical reconstruction is excellent, she is left with severe restriction of her elbow RoM. Although you are keen to improve her RoM and function, colleagues are cautioning against vigorous physiotherapy as they fear the patient may develop heterotopic ossification. You wonder if there is any real evidence for these fears.

Search Strategy

MEDLINE 1966 – 02/07, CINAHL 1982 – 02/07, AMED 1985 – 02/07, SPORTDiscus 1830 – 02/07, EMBASE 1996 – 02/07, via the OVID interface. In addition to the Cochrane database and PEDro database were also searched.
Medline, CINAHL, AMED, SPORTDiscus, EMBASE, Cochrane database for systematic reviews, PEDro: (ossification) AND (physical therapy techniques) AND (exercise) AND (physiotherapy) AND (physical therapy techniques OR exercise OR physiotherapy) AND (elbow) AND (ossification AND (physical therapy techniques OR exercise OR physiotherapy) AND elbow). LIMITS human AND English Language.

Search Outcome

No papers were found specific to the clinical scenario.

Clinical Bottom Line

In the absence of any relevant evidence it is not possible to determine whether vigorous physiotherapy in young adults following elbow ORIF will increase the occurrence of heterotropic ossification.