• Giuseppe Giannicola, David Polimanti, Gianluca Bullitta, Federico M Sacchetti, and Gianluca Cinotti.
• Department of Orthopedic Surgery, "Sapienza" University of Rome, Rome, Italy. Electronic address: giannicola.giuseppe@gmail.com.
• Injury. 2014 Mar 1;45(3):540-5.

Introduction And AimComplex elbow instability (CEI) is one of the most troublesome pathologies that orthopaedic surgeons have to face. One of the key requirements regarding the CEI surgical treatment is an early rehabilitation programme to avoid the elbow stiffness caused by a long period of immobilisation. Although this is well known, no study has ever examined how, and to what extent, the functional range of motion (ROM) is recovered during the various stages of a prompt rehabilitation. Our aims were: (1) to prospectively analyse the pattern of ROM recovery in a series of patients with CEI who underwent early rehabilitation and (2) to identify the period of time during rehabilitation in which the greatest degree of motion recovery is obtained.Materials And MethodsA total of 76 patients (78 elbows) with CEI were followed up for 2 years. All the patients underwent anatomical and stable ostheosynthesis of all the fractures, radial head replacement in Mason III fractures, ligament injuries reconstruction and early rehabilitation that started 2 days after surgery. Two surgeons evaluated the ROM with a hand-held goniometer every 3 weeks for the first 3 months, then at 6, 12 and 24 months after surgery.ResultsAt the 3-week follow-up, the mean flexion (F), extension (E), pronation (P) and supination (S) were 113°, 29°, 60° and 62°, respectively. At the 6-week and 9-week follow-up, F, E, P and S were 119°, 23°, 70° and 69° and 123°, 24°, 72° and 71°, respectively. At the 3-month follow-up, these values were 131°, 18°, 76° and 72°, while at the 6-month follow-up they were 136°, 15°, 79° and 77°, respectively. Thereafter, the ROM improvement was not significant.DiscussionThis study shows that the first 6 months represent the critical rehabilitation period to obtain a functional elbow; indeed, 70% of the patients recovered functional ROM between the third and sixth month, though the recovery of flexion proved to be slower than that of the other elbow movements. Thereafter, improvement continued, though at a lower rate, until the end of the first year, when approximately 80% of the patients had recovered the functional ROM.ConclusionsFollowing CEI surgical treatment, a rehabilitation programme needs to be started promptly and continued for at least 6 months because a significant improvement of ROM occurs prevalently in this period, which should be considered the critical time period to obtain a functional elbow in a majority of patients.Copyright © 2013 Elsevier Ltd. All rights reserved.

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