Olecranon Fracture Surgery (ORIF)

Physical Therapy Protocol

Precautions:

• Avoid aggressive elbow flexion ROM for 4–6 weeks.
• Avoid biceps strengthening for 6 weeks.
• Avoid closed kinetic chain exercises for 6–8 weeks.

Phase I – Immediate Post-Operative Phase (Weeks 0–4)

Goals:

• Protect healing site (4–6 weeks).
• Decrease pain and inflammation.
• Decrease muscular atrophy.
• Promote tissue healing.

Post-Operative Week 1:

• Brace: Posterior splint at 90° elbow flexion for 10 days.
• ROM:
  • Wrist AROM (flexion/extension) immediately postoperative.
  • Elbow: Postoperative compression dressing for 5–7 days.
  • Wrist (graft site): Compression dressing 7–10 days as needed.
• Exercises:
  • Gripping exercises.
  • Wrist ROM.
  • Shoulder isometrics (No shoulder ER).
• Cryotherapy: Apply to elbow joint as needed.

Post-Operative Week 2:

• Brace: Hinged elbow brace locked at 90° flexion when not in therapy.
• Exercises:
  • Continue prior exercises.
  • Initiate PROM of elbow 30°–100° (greater extension acceptable).
  • Initiate elbow extension isometrics (sub-painful).
  • Continue wrist ROM exercises 4–5x daily.
  • Initiate light scar mobilization over distal incision.
  • No biceps or active elbow flexion.
  • Continue wrist ROM exercises 6–8x daily.
• Cryotherapy: Continue ice to elbow.

Post-Operative Week 3:

• Brace: Hinged elbow brace open to ROM as above.
• Exercises:
  • Continue prior exercises.
  • Elbow ROM 6–8x daily.
  • Initiate active ROM for wrist and elbow (no resistance).
  • Continue PROM/AAROM elbow motion.
  • Elbow ROM (minimal): 15°–105°, progress extension as tolerated.
  • Initiate shoulder rehab program:
    • Tubing IR/ER.
    • Full can.
    • Lateral raises.
    • Elbow extension.
  • Initiate light scapular strengthening.
  • May incorporate bicycle for lower extremity strength & endurance.

Post-Operative Week 4:

• Brace: Unlock completely.
• ROM: Elbow 0°–125°.
• Exercises:
  • Begin light resistance exercises for arm:
    • Wrist curls, extensions, pronation, supination.
    • Elbow extension.
  • Progress shoulder program emphasizing rotator cuff and scapular strengthening.
  • Initiate shoulder strengthening with light dumbbells.
  • Initiate Thrower’s Ten if overhead athlete.

Phase II – Intermediate Phase (Weeks 5–8)

Goals:

• Gradual increase to full ROM.
• Promote healing of repaired tissue.
• Regain and improve muscular strength.
• Restore full function of graft site.

Post-Operative Week 5:

• ROM: Elbow 0°–135°.
• Brace: Discontinue hinged elbow brace.
• Exercises: Progress all shoulder and UE exercises (progress weight by 1 lb).

Post-Operative Week 6:

• AROM: 0°–145° without brace or full ROM.
• Exercises:
  • Continue Thrower’s Ten Program.
  • Progress elbow strengthening exercises.
  • Initiate shoulder external rotation strengthening.
  • Progress shoulder program.
  • Initiate biceps strengthening.

Post-Operative Week 7:

• Exercises:
  • Progress Thrower’s Ten Program (increase weights).
  • Initiate PNF diagonal patterns (light).

Phase III – Advanced Strengthening Phase (Weeks 9–14)

Goals:

• Increase strength, power, and endurance.
• Maintain full elbow ROM.
• Gradually initiate sporting activities.

Post-Operative Week 8:

• Exercises:
  • Initiate eccentric elbow flexion/extension.
  • Continue isotonic forearm & wrist program.
  • Continue Thrower’s Ten Program.
  • Manual resistance diagonal patterns.
  • Initiate plyometric exercise program:
    • Chest pass.
    • Side throw close to body.
  • Continue stretching calf and hamstrings.

Post-Operative Week 10:

• Exercises:
  • Continue all prior exercises.
  • Progress plyometrics to two-hand drills away from body:
    • Side-to-side throws.
    • Soccer throws.
    • Side throws.

Phase IV – Return to Activity Phase (Weeks 12–16)

Goals:

• Continue increasing strength, power, and endurance of upper extremity musculature.
• Gradual return to sport activities.

Post-Operative Week 12:

• Exercises:
  • Continue strengthening program (emphasis on elbow & wrist).
  • Maintain full elbow ROM.
  • Initiate one-hand plyometric throwing (stationary throws).
  • Initiate one-hand wall dribble.
  • Initiate one-hand baseball throws into wall.
  • Begin interval throwing program Phase I.
  • Initiate hitting program.

Post-Operative Weeks 14–16:

• Exercises:
  • Continue interval throwing program.
  • Gradual return to sports.