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Fracture ng Olecranon (ORIF)

Paggaling pagkatapos ng surgical fixation ng isang olecranon (tulis ng siko) fracture, pagprotekta sa repair ng triceps habang ibinabalik ang paggalaw, gamit ang isang simpleng sling at isang staged return ng active extension.

Ilustrasyon ng siko kung saan ang olecranon (ang dulo ng siko) ay nakapirmis gamit ang metal wire at mga pin.
Isang olecranon fracture sa dulo ng siko, na pinanatili sa pamamagitan ng internal fixation. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protocol na ito ay nagsisilbing gabay sa iyong paggaling pagkatapos ng surgical fixation ng fracture ng olecranon (ang matulis na bahagi ng buto sa iyong siko) gamit ang open reduction and internal fixation (ORIF), na isinagawa ni Dr Kieran Hirpara sa Mater Private Hospital Rockhampton. Nagsisimula ito sa iyong home exercise program, na sinusundan ng structured clinical protocol na isinulat para sa iyong physiotherapist o hand therapist. Dalhin ang pahinang ito o ang PDF nito sa iyong unang therapy visit upang manatiling coordinated ang iyong rehabilitasyon. Maaaring i-adjust ng iyong therapist ang plano depende sa pag-unlad ng iyong paggaling.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga rooms. Madalas na nakatutulong ang pagkuha ng larawan ng sugat at pag-email nito para masuri.

Ano ang dapat asahan

Ang olecranon ay ang matulis na bahagi ng buto sa iyong siko. Ang malaking kalamnan ng triceps sa likod ng iyong braso ay nakakabit dito, at bumubuo ito ng bahagi ng hinge joint sa loob ng siko. Kapag nabali ang olecranon, ang hila ng triceps ay may tendensiyang humila palayo sa nabaling piraso, kaya ang bali ay inaayos sa pamamagitan ng operasyon, maaaring gamit ang wire-and-pin "tension band" (para sa malinis at tuwid na bali) o gamit ang plate at screws (para sa mas nadurog o may anggulong bali). Ang fixation ay ginawa upang pagdikitin ang buto nang sapat na matatag upang maaari mo nang simulan ang paggalaw ng siko nang maaga.

Ang buong layunin ng rehabilitasyong ito ay isang balancing act. Ang siko na nananatiling hindi gumagalaw nang masyadong matagal ay mabilis na tumitigas, kaya nais naming mapagalaw ito nang maaga. Ngunit ang parehong kalamnan ng triceps na humihila sa bali ay ang kalamnan na nagtutuwid ng iyong siko, kaya sa unang anim na linggo, pinoprotektahan namin ang repair sa pamamagitan ng pag-iwas sa active straightening, habang malayang ginagawa ang pagbaluktot ng siko at pag-ikot ng forearm. Kapag nagkaroon na ng oras ang buto na maghilom, ang pagtutuwid ay unti-unting ibabalik: una ay gamit lamang ang bigat ng iyong braso, at sa kalaunan lamang laban sa resistance.

Para sa pamamahala ng sugat, pamamaga, at peklat, tingnan ang gabay ng practice sa wound care.

Mahalagang malaman mula sa simula na kahit pagkatapos ng isang maayos na fixation ng olecranon fracture, karamihan sa mga tao ay naiiwang may maliit at permanenteng pagkawala ng huling 10–15 degrees ng full straightening. Ito ay normal, bihirang mapansin sa pang-araw-araw na buhay, at hindi senyales na may anumang nagkamali.

Mga pag-iingat at limitasyon

Gawin

  • Isuot ang iyong simple sling para sa ginhawa at suporta, at tanggalin ito para sa iyong mga ehersisyo. Hindi mo kailangan ng rigid splint o brace.
  • Simulan nang maaga ang pagbaluktot (bending) ng siko at pag-ikot (rotating) ng forearm (palad na nakaharap sa itaas / palad na nakaharap sa ibaba), sa loob ng mga limitasyong komportable.
  • Panatilihing malayang gumagalaw ang iyong kamay, pulso, at balikat, at pumiga ng bola upang mapanatiling malakas ang iyong grip.

Huwag gawin

  • Huwag aktibong ituwid (actively straighten) ang iyong siko gamit ang sariling lakas ng kalamnan sa unang 6 na linggo; hayaan itong tumuwid sa pamamagitan lamang ng gravity. Ang aktibong pagtutuwid ay humihila sa triceps at maaaring magdulot ng paghihiwalay (distract) ng fracture.
  • Huwag gumawa ng anumang resisted o weighted straightening hanggang sa humigit-kumulang 3 buwan, kapag pinayagan na ito ng iyong therapist.
  • Huwag magbuhat, magtulak, o humila gamit ang inooperahang braso, at huwag itong gamitin sa pagdadala ng bigat (bear weight), sa mga unang linggo.

Ito ang mga ehersisyo mula sa iyong handout, para sa pagbawi ng paggalaw ng iyong siko at forearm. Tanggalin ang iyong sling para sa iyong mga ehersisyo. Simulan ang mga ito ayon sa gabay ni Dr Hirpara at ng iyong therapist.

Iyong mga ehersisyo

Gamitin ang kabilang kamay upang dahan-dahang itiklop pa lalo ang inoperahang siko patungo sa flexion.

Kieran Hirpara 4.0

Pasibong pleksyon ng siko

Ipahinga ang iyong inoperahang braso nang nakaharap pataas ang palad. Gamitin ang iyong kabilang kamay upang dahan-dahang itiklop ang inoperahang siko hanggang sa kung saan ito komportable, tulungan itong gumalaw sa halip na gamitin ang sariling mga kalamnan ng inoperahang braso. Panatilihin ito nang ilang segundo sa dulo ng komportableng range, pagkatapos ay dahan-dahang hayaan itong bumalik sa pagtuwid. Binubuo nito ang iyong pagtiklop (flexion) nang hindi binibigatan ang repair.

10 beses, 3–4 beses sa isang araw

Ibaluktot at ituwid ang siko nang nakaharap sa itaas ang palad.

Kieran Hirpara 4.0

Aktibong pagbaluktot ng siko

Habang nakaharap pataas ang iyong palad at ang iyong itaas na braso ay nakadikit sa iyong gilid, dahan-dahang itiklop ang iyong siko hangga't kaya mo, pagkatapos ay hayaan itong bumalik sa tuwid nang may kontrol. Sa unang anim na linggo, hayaang tumuwid ang siko gamit ang grabidad — HUWAG itong itulak nang tuwid gamit ang sarili mong mga kalamnan.

10–15 beses, 3–4 beses sa isang araw

Habang ang siko ay nasa gilid, ang forearm ay umiikot nang nakaharap ang palad pababa at nakaharap ang palad pataas.

Kieran Hirpara 4.0

Rotasyon ng forearm

Panatilihing nakadikit ang iyong siko sa iyong tagiliran at nakabaluktot nang halos right angle. Dahan-dahang ituon ang iyong palad paitaas sa kisame, manatili sa posisyong ito nang 3–5 segundo, pagkatapos ay ituon ito paibaba sa sahig. Panatilihing hindi gumagalaw ang siko at nakadikit sa iyong katawan sa buong proseso. Maaari mong dahan-dahang tulungan ang paggalaw gamit ang iyong kabilang kamay.

10 beses sa bawat direksyon, 3–4 beses sa isang araw

Pagpisil ng soft ball o putty sa kamay.

Kieran Hirpara 4.0

Pagpapalakas ng grip (kapit)

Pisilin ang isang malambot na bola o isang roll ng putty sa iyong kamay, hawakan nang ilang segundo, pagkatapos ay bitawan. Pinapanatili nitong malakas ang iyong kamay at forearm habang protektado ang iyong siko. Hindi nito binibigatan ang repair sa siko.

10–15 piga, 2–3 beses sa isang araw

Pananatiling hindi gumagalaw ng nakabaluktot na siko laban sa resistensya ng kabilang kamay.

Kieran Hirpara 4.0

Isometric elbow-bend hold

Habang nakabaluktot ang iyong siko at nakaharap pataas ang iyong palad, ilagay ang iyong kabilang kamay sa ilalim ng iyong forearm. Dahan-dahang subukang itiklop pa lalo ang siko habang pinapanatili itong hindi gumagalaw ng iyong kabilang kamay, upang gumana ang kalamnan ngunit hindi gumagalaw ang braso. Hawakan nang dahan-dahan, pagkatapos ay i-relax. Ito ay isang muscle-activation (isometric) drill — pinapagana nito ang mga bending muscles lamang at HINDI binibigatan ang triceps o ang repair.

Hawakan nang 5 segundo, 5–10 beses, 2–3 beses sa isang araw

Pagtuwid ng siko gamit ang sariling lakas ng kalamnan laban sa grabidad.

Kieran Hirpara 4.0

Aktibong extension ng siko (laban sa grabidad)

Simulan lamang ito kapag pinayagan na ng iyong surgeon o therapist, karaniwan ay mula anim na linggo. Habang suportado ang iyong itaas na bahagi ng braso, dahan-dahang ituwid ang iyong siko gamit ang sarili mong lakas ng kalamnan, pagkatapos ay itiklop itong muli nang may kontrol. Gumalaw laban sa grabidad lamang — HUWAG magdagdag ng anumang bigat o resistance hanggang sa payagan ka ng iyong therapist (karaniwan ay bandang tatlong buwan).

10 beses, 2–3 beses sa isang araw — mula linggo 6 lamang

Pagtuwid ng siko laban sa hila ng isang resistance band.

Kieran Hirpara 4.0

Resisted band extension

Ito ay isang exercise para sa huling yugto, na sisimulan lamang pagkalipas ng humigit-kumulang tatlong buwan kapag pinayagan na ito ng iyong therapist. I-angkla ang isang light resistance band at ituwid ang iyong siko laban sa hila nito, pagkatapos ay dahan-dahang ibalik. Magsimula sa pinakamagaang band at mag-progress sa light weights (humigit-kumulang 0.5–2 kg) ayon lamang sa gabay. Ang resisted straightening ay direktang nagbibigay ng load sa triceps at sa repair, kung kaya't ito ay ipinagpaliban.

10–15 beses, 3 beses sa isang linggo — mula ~3 buwan lamang

Simulan lamang ang mga ehersisyo sa ibaba ayon sa gabay ni Dr Hirpara at ng iyong hand therapist, at manatili sa anumang range at limitasyong ibinigay sa iyo. Sadyang dalawang ehersisyo lamang ang narito. Passive at active na pagbaluktot (bending) ang kailangan ng siko sa simula — mas madali itong tumitigas sa extension kaysa sa mawalan ng flexion — habang pinoprotektahan ang triceps repair. Huwag magbuhat, tumulak o humila gamit ang inoperahang braso, at huwag itong gamitin sa pagdadala ng bigat sa mga unang linggo; ang hila ng triceps ay eksaktong puwersa na pinoprotektahan ng fixation. Panatilihing malayang gumagalaw ang iyong kamay, pulso at balikat sa pagitan ng mga session. Itigil ang anumang nagdudulot ng matalas na sakit sa bahagi ng siko.

Ang iyong clinical protocol

Ang natitirang bahagi ng pahinang ito ay ang clinical protocol para sa isang olecranon fracture na ginamot sa pamamagitan ng open reduction and internal fixation. Ang seksyong ito ay ibibigay sa iyong physiotherapist o hand therapist, at ang bawat phase sa ibaba ay nagsisimula sa isang paliwanag sa simpleng Ingles tungkol sa nangyayari. Ang pinakamahalagang panuntunan na nagpapaiba sa protocol na ito mula sa isang generic na elbow fracture ay ang triceps protection: ang active extension ay ipinagpapaliban hanggang ~6 na linggo at ang resisted extension hanggang ~3 buwan, dahil ang triceps ay nakakabit sa olecranon at nagbibigay ng load sa fixation.

Bago ang paggamot, suriin ang x-ray ng pasyente, operation report at medical history, at makipag-ugnayan sa treating surgeon tungkol sa fixation construct (tension-band wiring vs plate), ang stability nito, at ang inaasahang prognosis.

Mga Linggo 0–1: immobilisation

Sa unang linggo, ang pokus ay ang pagpapahinga ng mga soft tissue, pagpapababa ng pamamaga, at pagpapanatiling gumagalaw ng lahat ng iba pa. Ang siko ay nakapahinga sa isang simple sling sa anggulong humigit-kumulang 90°, na tinatanggal para sa mga ehersisyo. Walang rigid posterior splint o brace.

Para sa iyong physiotherapist:

  • Immobilisation: simple sling, siko sa ~90°, tinatanggal para sa mga ehersisyo (KH override: walang posterior splint o brace).
  • Mga Layunin: pagpapahinga ng soft-tissue; kontrol sa oedema (elevation, gentle compression, cold).
  • Mga Ehersisyo: active range of motion ng kamay, pulso (wrist) at balikat; ang gentle active range of motion ng siko at forearm ay maaaring magsimula mula sa araw 2–3 kung stable ang construct.
  • Mga Pag-iingat: non-weight-bearing na upper limb; bawal ang pagbuhat, pagtulak o paghila; bawal ang active elbow extension.
  • Mga Pamantayan para mag-progress: paghilom ng sugat at pagbaba ng pamamaga.

Mga Linggo 1–6: protektadong paggalaw (limitado ang extension)

Ito ang phase para sa proteksyon ng triceps. Ang pagbaluktot (bending) ay unti-unting pinauunlad habang ang pagtuwid (straightening) ay ginagawa nang passive o sa pamamagitan lamang ng gravity, hinding-hindi gamit ang sariling lakas sa pagtuwid ng siko. Ang sling ay unti-unting inaalis simula sa ika-4 na linggo.

Para sa iyong physiotherapist:

  • ROM ceiling: ang flexion ay pinauunlad ng humigit-kumulang 10° bawat linggo sa loob ng tension-free range; ang layunin ay full passive extension, tension-free flexion hanggang 120°, at full forearm rotation sa ika-6 na linggo. Passive extension lamang: WALANG active extension.
  • Mga Ehersisyo: active at active-assisted flexion kasama ang pronation/supination; ang passive range of motion ay maaaring magsimula sa ~ika-4 na linggo. Cuff, periscapular at forearm isometrics lamang, hindi elbow extension.
  • Orthosis: unti-unting alisin ang sling sa ika-4 na linggo (isusuot sa labas ng bahay at sa gabi pagkatapos nito para sa ginhawa).
  • Pamantayan para sa pag-usad: full passive extension, flexion hanggang ~120°, full rotation; pain ≤3/10.

Mga Linggo 6–12: ipinakilala ang active extension

Kapag ang buto ay nagkaroon na ng anim na linggo upang maghilom, muling ipinapakilala ang active straightening, laban sa gravity lamang at walang idinagdag na bigat. Ang pagbaluktot (bending) ay isinasulong tungo sa isang full arc, at ang weight-bearing sa pamamagitan ng braso ay unti-unting pinauunlad.

Para sa iyong physiotherapist:

  • Mga Layunin: kumpletuhin ang motion arc; ipakilala ang gentle active extension.
  • Mga Ehersisyo: active elbow extension laban sa gravity lamang mula linggo 6; isulong ang flexion hanggang maging full (layunin ang full tension-free arc sa bandang linggo 9). Isulong ang weight-bearing mula tabletop → wall → quadruped ayon sa kakayahan. Maaaring magsimula ang progressive resistive exercise sa flexion/rotation, ngunit NO resisted extension pa rin: ito ay pinapanatili hanggang 3 buwan.
  • Pamantayan para sa pag-unlad: full active arc; walang paglala ng extension lag; radiographic union.

3–6 buwan: resisted extension at pagbabalik

Ang resisted straightening (ang hakbang na direktang naglalagay ng load sa triceps at sa repair) ay magsisimula lamang ngayon, kapag naghilom na ang fracture.

Para sa iyong physiotherapist:

  • Ang resisted elbow extension ay magsisimula sa ~3 buwan (mga band na mag-pro-progress sa light weights, ~0.5–2 kg / 1–5 lb, 3×/linggo).
  • Mga exercise na specific sa sport at trabaho mula ~4.5 buwan.
  • Ang pagbubuhat at mabigat na paggawa ay babalik kapag nakamit na ang full strength at union, karaniwan ay sa loob ng 6 na buwan.
  • Karaniwan ang hardware removal pagkatapos ng olecranon fixation (lalo na ang tension-band wires, ang pinakamadalas tanggaling implant sa katawan) at karaniwang ginagawa pagkatapos ng union, para sa relief ng prominent o irritating hardware, hindi bilang isang routine step.

Pagbabalik sa trabaho at aktibidad

Ang magaan na paggamit ng braso para sa pag-aalaga sa sarili (hands-on-lap) ay maaring gawin nang maaga basta't sinusunod ang mga pag-iingat sa itaas, ngunit anumang bagay na nagbibigay ng bigat o load sa siko ay dapat munang ipagpaliban. Ang pagbaluktot at pag-ikot ng forearm ay karaniwang komportable na pagdating ng mga anim na linggo; ang aktibong pagtuwid ay bumabalik mula anim na linggo at unti-unting bumubuti sa mga sumunod na linggo.

Ang mga mas mabibigat na gawain ay dadaan sa mga yugto: walang resisted o weighted na pagtuwid hanggang sa humigit-kumulang tatlong buwan, sport- at job-specific na pagsasanay mula sa humigit-kumulang apat at kalahating buwan, at pagbabalik sa pagbubuhat at mabibigat na manwal na trabaho karaniwan ay sa loob ng anim na buwan, kapag pinahintulutan na ito ng iyong lakas at ng paghilom ng buto. Ang mga desk-based at magagaan na tungkulin ay karaniwang maaaring ituloy nang mas maaga; talakayin ang timing nito kay Dr Hirpara sa iyong review, dahil nakadepende ito sa iyong trabaho at kung aling braso ang na-operahan. Ang pagmamaneho ay maaaring ituloy kapag wala ka na sa sling at ligtas nang makokontrol ang sasakyan gamit ang parehong braso, gaya ng kumpirmasyon sa iyong review.

Tandaan na asahan ang maliit at permanenteng pagkawala ng huling 10–15 degrees ng pagtuwid; ito ay normal at karaniwang walang epekto sa pang-araw-araw na function.

Pagkatapos ng iyong protocol

Ang protocol na ito ay kasabay ng pangkalahatang payo sa paggaling ng klinika: tingnan ang pamamahala ng sakit pagkatapos ng operasyon at pag-aalaga ng sugat. Para sa mismong pinsala, tingnan ang olecranon fracture. Ang phased plan sa itaas ay naaayon sa mga nailathalang rehabilitation protocol pagkatapos ng olecranon ORIF, at ang iyong patuloy na paggaling ay ginagabayan nang indibidwal ng iyong physiotherapist o hand therapist ayon sa pag-unlad ng iyong siko.


Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Olecranon Fracture — Open Reduction Internal Fixation (ORIF) — Post-operative Rehabilitation

Topic scope: Post-operative rehabilitation after ORIF of a displaced olecranon fracture — tension-band wiring (TBW) for simple transverse patterns, or plate-and-screw fixation for comminuted / oblique / Monteggia-type / proximal-ulna patterns. The olecranon fracture is an intra-articular fracture of the extensor mechanism: the fixation construct must resist the triceps pull that distracts the fragment, and the rehabilitation is built around protecting that construct while preventing the stiffness to which the elbow is highly prone.

Defining principle (the inverse of an arthrolysis): unlike a stiff-elbow release, here there is a fixation construct to protect, and the deforming force is the triceps. So active and resisted elbow EXTENSION — and lifting / pushing — are restricted early, while flexion and forearm rotation are advanced relatively freely to prevent stiffness. Dr Hirpara's practice override: the operated elbow is rested in a simple sling, not a posterior splint or brace; active extension is withheld for 0–6 weeks (protecting the tension band / triceps insertion), resisted extension is delayed to ~3 months, flexion is advanced ~10°/week, and the patient is counselled to expect a permanent 10–15° loss of terminal extension.

Evidence-strength flag: MODERATE-to-STRONG. Two concordant institutional physiotherapy protocols (Brigham & Women's Hospital; The Christ Hospital / Rao) give explicit phase timelines, and the biomechanical rationale — anatomic reduction plus stable fixation to permit early motion of an intra-articular fracture — is universally agreed. Consensus is strong on early protected motion + delayed active / resisted extension and triceps loading. The evidence is weaker (equipoise-level) on TBW vs plate, and on operative vs non-operative management in the elderly.


Phased rehabilitation timeline

Phase Window Sling / immobilisation ROM / use Strengthening Criteria to progress
I — Immobilisation Weeks 0–1 Simple sling at ~90° (KH — no posterior splint/brace), off for exercises Active hand/wrist/shoulder ROM; gentle active elbow + forearm ROM from day 2–3 if stable; NO active extension — (oedema control) Wound and swelling settling
II — Protected motion, extension restricted Weeks 1–6 Wean sling at week 4 (out-of-house + night thereafter) Flexion advanced ~10°/week in a tension-free zone; passive extension only; PROM may begin ~wk 4; goal full passive extension + flexion to 120° + full rotation by 6 wk Cuff / periscapular / forearm isometrics only Full passive extension, flexion ~120°, full rotation; pain ≤3/10
III — Active extension introduced Weeks 6–12 Discontinued Active extension against gravity only from wk 6; advance flexion to full (full tension-free arc by ~wk 9); progress weight-bearing tabletop → wall → quadruped PRE to flexion/rotation; still NO resisted extension Full active arc; no worsening extension lag; radiographic union
IV — Resisted extension + return 3–6 months — Return to lifting/loading staged Resisted extension from ~3 months (bands → light weights 1–5 lb, 3×/wk); sport/job-specific ~4.5 mo Full strength + union; lifting/heavy labour ~6 mo

Evidence by theme

The triceps-pull rule (the rehab-defining constraint) — Consensus, strong biomechanical rationale

The triceps inserts on the olecranon; active and resisted extension distract the fracture and load the tension band. Active extension against gravity is therefore deferred to ~6 weeks and resisted extension to ~3 months. This is the single most important rule distinguishing olecranon ORIF from a generic elbow-fracture rehabilitation, and both published protocols enforce it (The Christ Hospital / Rao explicitly prohibit active extension for the first six weeks).

Early protected motion to prevent stiffness — Strong consensus

There is universal agreement that an intra-articular extensor-mechanism fracture needs early motion to prevent stiffness; how early depends on construct stability and surgeon confidence. Brigham permits active ROM from day 2–3; the more conservative Christ / Rao protocol protects the first weeks with no active extension. The tension throughout is "prevent stiffness" versus "protect the triceps repair," resolved by advancing flexion and rotation freely while restricting extension.

Construct choice — TBW vs plate — Moderate / equipoise

Both constructs aim to be stable enough for early motion. TBW is simpler and adequate for simple transverse fractures but carries the highest symptomatic-hardware / removal rate and can lose compression in comminuted or osteoporotic bone. Plate fixation better controls comminution, oblique and diaphyseal-extension patterns; Hume & Wiss's randomized study favoured plate over TBW for comminuted patterns, while Anderson et al. reported a mean ~13.5° flexion contracture after plating. Rehabilitation phases are broadly the same — a more stable construct simply allows the surgeon to liberalise motion sooner.

Operative vs non-operative in the elderly — Moderate (RCT, equipoise)

A prospective RCT of displaced olecranon fractures in elderly patients was stopped early for a high operative complication rate, with comparable patient-reported outcomes — shifting practice toward non-operative management and earlier free mobilisation in low-demand older patients. Geriatric locking plates reduce fixation failure in osteoporotic bone but still carry meaningful complication and implant-failure rates.

Expected residual deficit — Moderate (corpus, observational)

Even with stable fixation and early motion, isolated olecranon fractures lose ~10–15° of terminal extension on average. Patients should be counselled that this is the expected norm, not a complication.

Hardware removal — Moderate (observational)

Olecranon hardware — especially TBW K-wires / wires — is the most commonly removed implant in the body; prominent subcutaneous hardware drives a high secondary-removal rate (up to roughly half of TBW cases in some series). Removal is typically performed after union (often ≥4–6 months) and largely for symptom relief, not as a routine staged step. Plate fixation has fewer wire-irritation issues but a non-trivial removal rate.


Evidence strength flags (summary)

  • STRONG / CONSENSUS: early protected motion to prevent stiffness; the triceps-pull rule deferring active extension to ~6 weeks and resisted extension to ~3 months (biomechanical rationale
  • two concordant institutional protocols).
  • MODERATE: TBW vs plate construct choice (Hume & Wiss; Anderson ~13.5° contracture after plating); operative vs non-operative in the elderly (RCT stopped early for operative complications); expected 10–15° terminal-extension loss; high TBW hardware-removal rate.
  • CONSENSUS / EXPERT: the precise phase timings (drawn from surgeon patient-guidance protocols rather than a rehabilitation RCT); the simple-sling immobilisation (KH practice override).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Chalidis BE, Sachinis NC, Samoladas EP, Dimitriou CG, Pournaras JD. Is tension band wiring technique the "gold standard" for the treatment of olecranon fractures? A long-term functional outcome study. J Orthop Surg Res. 2008;3:9. DOI: 10.1186/1749-799X-3-9
  • Hume MC, Wiss DA. Olecranon fractures: a clinical and radiographic comparison of tension band wiring and plate fixation (randomized comparison; plate favoured for comminuted patterns). (Cited in retrieved corpus text.)
  • Anderson et al. — mean ~13.5° flexion contracture after olecranon plate fixation (retrieved corpus text).
  • Prospective RCT, operative vs non-operative management of displaced olecranon fractures in the elderly — stopped early for a high rate of complications in the operative group, comparable patient-reported outcomes (retrieved corpus text).
  • Geriatric olecranon locking-plate case series — major/minor complication and implant-failure rates (J Shoulder Elbow Surg, retrieved corpus text).
  • Retrieved corpus text: isolated olecranon fractures lose an average of ~10–15° of terminal extension despite stable fixation and early ROM; anatomic reduction and early range of motion to restore functional elbow motion and strength; high re-operation / hardware-removal rate after TBW.

Published rehabilitation protocols (URLs)

  • The Christ Hospital / Rao — "Olecranon ORIF Physical Therapy Protocol." https://www.thechristhospital.com/landingpages/Documents/Rao%20PT%20Protocols/Operative/Elbow/Rao%20Olecranon%20ORIF%20r1.pdf
  • Brigham & Women's Hospital, Department of Rehabilitation Services — "Elbow Fracture Post-Op (Radial Head / Olecranon ORIF) Hand Therapy Guideline" (2021). https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/elbow-fracture-orif-hand-therapy-protocol.pdf
  • Physiopedia — "Olecranon Fracture" (general background). https://www.physio-pedia.com/Olecranon_Fracture

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Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees


Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.


Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.