Best Evidence Topics
  • Send this BET as an Email
  • Make a Comment on this BET

Is vigorous physiotherapy contraindicated after elbow fracture?

Three Part Question

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

Clinical Scenario

A 22 year old male had a right elbow ORIF following a fall on an outstretched hand whilst skateboarding. There were no complications with his surgery, however he has significant restriction in active range of movement at the elbow on initial assessment.
You are aware of the possible complications of heterotopic ossification, so you refer back to previous research conducted in 2007 that highlighted no available relevant evidence to support the development of this complication.
You wonder if there are any recent developments in the literature to a support this notion.

Search Strategy

MEDLINE 02/07 – 04/12, CINAHL 02/07 – 04-12, AMED 02/07 – 04/12, SPORTDiscus 02/07 – 04/12, EMBASE 02/07 – 04/12 via the OVID interface. In addition the Cochrane database and PEDro database were also searched.
(elbow) AND (ossification) AND (physical therapy techniques) AND (exercise) AND (physiotherapy). LIMITS human AND English Language.

Search Outcome

No papers were found specific to the clinical scenario.


A recent Cochrane review produced in 2011 – Early Mobilisation for Elbow Fractures in Adults (Review)included one trial. This highlighted no significant difference between early vs delayed mobilisation in pain, range of movement or activities of daily living. This paper was not specific to this clinical scenario as it does not refer to the vigour of the physiotherapy in relation to heterotopic ossification. It is also worth noting that this trial should be used with caution due to its high risk of detection and reporting bias.

Clinical Bottom Line

There are no further developments in evidence to determine whether vigorous physiotherapy in young adults following elbow ORIF will increase the occurrence of heterotopic ossification.