Olecranon fracture fixation — rehabilitation protocol

Establish the fracture pattern, fixation stability, triceps and wound status, and additional repairs. The orthopaedic surgeon should specify permitted flexion and extension, how extension is performed and whether a brace is needed.

Active movement is not resistance exercise. If active extension has not been cleared, use assisted or passive extension within the permitted range without triceps contraction. Do not impose a six-week ban on active extension for every patient. ^[1],[2],[3]

A. Tension band wiring: most often used for a simple transverse fracture. Stable fixation permits early movement but still needs protection from loading. Monitor tenderness over wires, increasing prominence under the skin and the wound. Do not force painful catching or a movement block. ^[1]

B. LCP plate: also used for comminution, more complex fracture patterns and poor bone quality. Early movement is desirable when stability permits. Bone loss, a small proximal fragment or additional reconstruction may require slower progression. A plate does not itself permit earlier weight-bearing. ^[2],[3]

Both pathways: progression depends on stability and healing, not just the implant name. Avoid forced flexion and resisted extension until cleared by the surgeon.

Reviews: usually first at around days 10–14 to assess the wound, skin over the implant, sensation, movement and exercise technique. Further visits and X-rays follow the surgeon’s plan; AO advises reviews every 10–20 days initially. Healing must be assessed before increasing loads. ^[1],[2],[3]

• More range: satisfactory wound healing and tolerated movement without increasing pain or swelling.
• Resistance: confirmed healing, maintained fracture alignment and fixation, a functional extensor mechanism and surgical clearance.
• Greater effort: union and adequate strength, control and movement for the intended activity.

Goal: reduce swelling, protect the wound and begin recovering movement.

• Sling or splint: usually briefly for comfort and soft-tissue protection. The surgeon specifies wear time and removal for exercise; instability or wound problems may require longer protection. ^[1],[2],[3]
• Positioning: support the forearm and upper arm without pressure on the olecranon. Move the fingers and wrist; elevate the hand for swelling.
• Flexion: gentle assisted movement without pushing. Deep flexion tensions tissues behind the elbow; do not force the wound to stretch.
• Extension: initially supported and assisted by the other limb or physiotherapist. Introduce active extension according to confirmed stability and instructions.
• Rotation: gentle pronation and supination with the forearm supported, unless associated injuries restrict this.

Short and regular: several brief sessions daily, with dosage set by the physiotherapist. No lifting, pushing, pulling or supporting body weight.

Goal: gradually improve flexion and extension while maintaining forearm rotation.

• Continue physiotherapy and home exercises. Measure movement regularly, particularly any extension deficit.
• Progress assisted to active movement when cleared. Increase range without jerking or forceful passive stretching.
• No triceps resistance: no bands, weights or strong isometric extensor contractions. Avoid push-ups, weight-bearing, pushing out of a chair or loading the operated limb through crutches or a walking frame.
• Do not rest the posterior elbow on a hard surface; protect skin over the implant.

No progress or deterioration: reassess rather than increasing exercise force. A painful block, worsening pain over fixation or a new active extension deficit requires review.

Goal: maintain movement and safely begin strengthening.

AO generally recommends protection from loading for 6–8 weeks. Time alone is insufficient: resistance requires clinical and radiographic assessment and surgical clearance. Comminution or delayed healing may postpone this stage. ^[1],[2],[3]

• Start with low resistance and short sets. Introduce triceps loading particularly gradually.
• Increase one variable at a time: resistance, repetitions or duration. Increased pain or swelling after exercise means the dose should be reduced.
• Weight-bearing, push-ups and heavy loading require confirmed union and adequate limb control.

There is no single safe weight allowance for every fixation. The surgeon sets limits based on healing and bone quality.

Goal: recover the strength and endurance needed for work and sport.

• After union, progress functional loads from light tasks towards activities requiring strength.
• Heavy work, contact sports and activities with a fall risk require individual clearance and a functional extensor mechanism.
• Driving requires safe vehicle control without a restrictive splint or medication that impairs performance.

Recovery may continue for many months. A small extension deficit may remain; persistent limitation should be assessed. Removal of an irritating implant may be considered after solid union but is not routine. ^[4]