Isolated Fracture of the Radial Head REHABILITATION RATIONALE Mason's classification of radial head fractures is the most widely

accepted and useful for treatment (Fig.2-9). Rehabilitation is based on this classification ( able 2-!). "#$% 2-! Mason Classification of Radial Head Fractures ype ype ' &escription (ondisplaced fracture )ften missed on radiograph *ositi+e posterior fat pad sign Marginal radial head fractures with displacement, depression, or angulation -omminuted fracture of the entire head -oncomitant dislocation of elbow or other associated in/uries

ype '' ype ''' ype '.

Figure 2- Mason classification of radial head fractures. (From #roberg M", Morrey #F0 Results of treatment of fracture dislocations of the elbow, Clin Orthop 2120139, 1945.) TREATMENT (ondisplaced type ' fractures re6uire little or no immobili7ation. "cti+e and passi+e R)M may be begun immediately after in/ury to promote full R)M. -onditioning in the form of elbow fle8ion and e8tension, supination and pronation isometrics, and wrist and shoulder isotonics can be implemented immediately (usually within the first wee9) after in/ury. :tress to the radial head is minimi7ed. hree to 2 wee9s of acti+e elbow fle8ion and e8tension may be used, along with wrist isotonics. ypes '' and ''' fractures usually re6uire open reduction internal fi8ation. Fre6uently, immobili7ation is re6uired for a brief time, followed by acti+e and passi+e R)M e8ercises. ype '. comminuted fractures fre6uently re6uire stabili7ation of the elbow /oint and e8cision of fragments and usually cause some functional limitation. Full R)M rarely returns and chronic elbow pain of the persists.

reatment for types ', '', ''', and '. fractures is described in able 2-;. "#$% 2-; Treat!ent of Radial Head Fractures in Athletes ype ype ' (nondisplaced) ype '' ype ''' ype '. (comminuted) <)pen reduction and internal fi8ation Radial Head Fracture ype ' fracture or type '' or ''' fracture treated with )R'F. *hase 1 > 'mmediate Motion *hase ?oals0 &ecrease pain and inflammation. Regain full wrist and elbow R)M. Retard muscular atrophy. 1 wee9 #egin elbow acti+e R)M and acti+eassisted R)M= minimal accepted R)M (1@ to 13@ degrees) by 2 wee9s. #egin puttyAgripping e8ercises. #egin isometric strengthening e8ercises (elbow and wrist) #egin isotonic strengthening e8ercises for wrist. *hase 2 > 'ntermediate *hase ?oals0 Maintain full elbow R)M. *rogress elbow strengthening e8ercises. ?radually increase functional demands. ! wee9s 'nitiate shoulder strengthening e8ercises= concentrate on rotator cuff. -ontinue R)M e8ercises for elbow (full fle8ion A e8tension). 'nitiate light resistance elbow fle8ion A e8tension (1 lb). 'nitiate acti+e-assisted R)M and passi+e R)M supination A pronation to tolerance. 2 wee9s -ontinue acti+e-assisted R)M and passi+e R)M supination A pronation to full range. *rogress shoulder program. *rogress elbow strengthening e8ercises. *hase ! > "d+anced :trengthening *hase reatment Minimal immobili7ation and early motion )R'F< and early motion )R'F and early motion if possible Radial head resection= chec9 distal /oint (%sse8$opresti in/ury)= guarded prognosis for return to sports

 ?oals0 Maintain full elbow R)M. 'ncrease strength, power, endurance. ?radually initiate sporting acti+ities. 5 wee9s -ontinue acti+e-assisted R)M and passi+e R)M to full supination A pronation. 'nitiate eccentric elbow fle8ion A e8tension. 'nitiate plyometric e8ercise program. -ontinue isotonic program forearm, wrist, and shoulder. -ontinue until 12 wee9s.

El"o# Arthro$last% REHABILITATION RATIONALE %lbow arthroplasty may be indicated for the following conditions0 *ain, instability, and bilateral an9ylosis, such as in patients with ad+anced stage ! or ; rheumatoid arthrosis that is unresponsi+e to medical management. Failed interpositional or anatomic arthroplasty. Failed prosthetic arthroplasty. "rthrodesis in poor functional position. "fter en bloc resection for tumor. &egenerati+e arthrosis after failed debridement and loose body e8cision. Rheumatoid arthrosis in which syno+ectomy and radial head e8cision ha+e failed. -ontraindications to elbow arthroplasty include the following0 "cti+e infection. "bsent fle8ors or flail elbow from motor paralysis. (oncompliant patient with respect to acti+ity limitations. 'nade6uate posterior s9in 6uality. 'nade6uate bone stoc9 or ligamentous instability with resurfacing implants. (eurotrophic /oint. %lbow prostheses are classified as semiconstrained (loose-hinge or sloppy-hinge), nonconstrained (minimally constrained), or fully contrained. Fully constrained prostheses are no longer used because of their unacceptable failure rate. Fra&tur Terisolasi $ada 'e$ala Radial REHABILITA(I RATIONALE Fra9tur 9epala radial berdasar9an 9lasifi9asi Mason merupa9an 9lasifi9asi yang paling banya9 diterima dan berguna untu9 pengobatan (?br.2-9). Rehabilitasi didasar9an pada 9lasifi9asi ini ( abel 2-!)

"#$% 2-! 'lasifi&asi Fra&tur 'e$ala Radial !enurut Mason ipe ipe ' Beterangan (ondisplaced fra9tur :ering tida9 tampa9 pada radiograf *ositif tanda pad posterior lema9 :ebagian 9epala radial fra9tur dengan pergeseran, depresi, atau angulasi Fra9tur 9ominuta dari seluruh 9epala &islo9asi si9u bersamaan atau ter9ait cedera lainnya.

ipe ''

ipe ''' ipe '.

TERA)I ipe 1 fra9tur nondisplaced (ondisplaced tipe 1 patah tulang memerlu9an sedi9it atau tanpa imobilisasi. R)M a9tif dan pasif dapat dimulai segera setelah cedera untu9 mening9at9an R)M penuh. *endingin berupa peregangan otot si9u fle9si dan e9stensi, supinasi dan pronasi , dan isotoni9 pergelangan tangan dan bahu dapat dila9sana9an segera (biasanya dalam minggu pertama) setelah cedera. e9anan pada 9epala radial di9urangi. iga sampai 2 minggu si9u fle9si dan e9stensi secara a9tif dapat diguna9an, bersama dengan isotonics pergelangan tangan. Fra9tur tipe '' dan ''' biasanya membutuh9an redu9si terbu9a dengan fi9sasi internal. :ering9ali, imobilisasi diperlu9an untu9 wa9tu yang sing9at, dii9uti dengan latihan R)M a9tif dan pasif. ipe '. fra9tur 9omunita sering membutuh9an stabilisasi sendi si9u dan e9sisi fragmen dan biasanya menyebab9an beberapa batasan fungsional. R)M penuh /arang 9embali dan nyeri si9u 9ronis terus berlan/ut. erapi untu9 fra9tur tipe ', '', ''' dan '. di/elas9an pada abel 2-;. "#%$ 2-; Tera$i Fra&tur 'e$ala Radial $ada Olahraga#an ipe ipe ' (nondisplaced) ipe '' ipe ''' ipe '. (Bomunita) <Redu9si terbu9a dan fi9sasi internal Fra&tur 'e$ala Radial erapi 'mobilisasi minimal dan gera9an awal )R'F< dan gera9an awal )R'F and gera9an awal /i9a memung9in9an Rese9si 9epala radial, peri9sa sendi distal (%sse8$opresti cedera), men/aga prognosis untu9 9embali 9e olahraga

Fra9tur tipe ' atau tipe '' atau fra9tur tipe ''' diterapi dengan )R'F. Fase ' > Fase ?era9an :egera u/uan0 Menurun9an nyer dan inflamasi. *emulihan pergelangan tangan dan si9u R)M. Menghambat atrofi otot. Minggu 1 Mulailah R)M a9tif pada si9u dan R)M acti+eassisted, minimal R)M (1@-13@ dera/at) dalam 2 minggu. Mulailah latihan mendempul A menceng9eram. Mulailah latihan penguatan peregangan otot (si9u dan pergelangan tangan. Mulailah latihan penguatan isotoni9 untu9 pergelangan tangan.

Fase 2 > Fase *eralihan u/uan0 Mempertahan9an R)M penuh pada si9u. *er9embangan latihan penguatan si9u. :ecara bertahap mening9at9an 9ebutuhan fungsional. Minggu ! Minggu 2 $an/ut9an R)M a9tif-yang dibantu dan supinasi A pronasi untu9 serang9aian penuh R)M pasif. Bema/uan program bahu Bema/uan latihan penguatan si9u. Fase ! > Fase *enguatan lan/ut u/uan 0 Mempertahan9an R)M penuh pada si9u. Menig9at9an 9e9uatan, power, daya tahan. Memulai 9egiatan olahraga secara bertahap. Minggu 5 Melan/ut9an R)M a9tif > dibantu dan R)M pasif untu9 supinasiA pronasi penuh. Memulai e9sentri9 si9u fle9si A e9stensi. Memulai program latihan pliometri9. $an/ut9an program isotoni9 lengan, pergelangan tangan, dan bahu. Memulai latihan penguatan bahu= 9onsentrasi pada manset rotator. $an/ut9an latihan R)M untu9 si9u (fle9si A e9stensi penuh). Memulai perlawanan ringan fle9si A e9stensi si9u (1 lb). Memulai R)M a9tif-yang dibantu dan supinasi A pronasi ditoleransi terhadap R)M pasif.

 $an/ut9an sampai 12 minggu. Arthro$lasti (i&u REHABILITATION RATIONALE "rtroplasti si9u dapat diindi9asi9an untu9 9ondisi beri9ut0 (yeri, 9etida9stabilan, dan bilateral an9ilosis, seperti pada pasien dengan stadium lan/ut ! atau ; rheumatoid arthritis yang tida9 responsif terhadap mana/emen medis. Begagalan interpositional atau artroplasti anatomi. Begagalan prosteti9 artroplasti. "rthrodesis dalam posisi fungsional yang buru9. :etelah en bloc rese9si untu9 tumor. &egeneratif arthrosis setelah debridement gagal dan e9sisi tubuh yang longgar. Rheumatoid arthritis di mana sino+e9tomi dan e9sisi 9epala radial telah gagal. Bontraindi9asi artoplasti si9u meliputi0 'nfe9si a9tif. "danya )tot fle9sor atau memu9ul-mu9ul si9u dari 9elumpuhan motori9. *asien patuh terhadap 9eterbatasan a9ti+itas. Burang memadainya 9ualitas 9ulit posterior. *ersediaan tulang yang tida9 ade9uat atau 9etida9stabilan ligamen dengan resurfacing implan. (eurotropi9 tulang sendi %lbow prostheses are classified as semiconstrained (loose-hinge or sloppy-hinge), nonconstrained (minimally constrained), or fully contrained. Fully constrained prostheses are no longer used because of their unacceptable failure rate. *rostesis si9u di9lasifi9asi9an sebagai semiconstrained (engsel-longgar atau engsel-tida9 rapi), nonconstrained (minimal dibatasi), atau seluruhnya contrained. *rostesis sepenuhnya dibatasi tida9 lagi diguna9an 9arena ting9at 9egagalan tida9 dapat diterima mere9a.