鹰嘴骨折（切开复位内固定术）
本方案指导您在接受肱骨鹰嘴（肘部骨性突起）骨折切开复位内固定术（ORIF）后的康复过程。该手术由基兰·希尔帕拉（Kieran Hirpara）医生在洛克汉普顿 Mater 私人医院实施。方案首先介绍您的家庭锻炼计划，随后是专为您的物理治疗师或手部治疗师制定的结构化临床方案。请在首次治疗访视时携带此页面或其 PDF 版本，以确保您的康复过程协调一致。您的治疗师可能会根据您的康复进展调整该计划。
如果您对术后伤口有任何疑虑，请与诊所联系。拍摄伤口照片并通过电子邮件发送以供审查通常很有帮助。
预期情况
鹰嘴是肘部的骨性突起。上臂后侧粗大的肱三头肌附着于其上，并构成肘关节铰链结构的一部分。当鹰嘴发生骨折时，肱三头肌的牵拉力倾向于将骨折块拉开，因此需通过手术进行固定：对于整齐、直线的骨折，采用钢丝和克氏针构成的“张力带”固定；对于粉碎性或成角骨折，则采用钢板和螺钉固定。内固定旨在牢固维持骨块对位，以便您能够早期开始活动肘关节。
本康复计划的核心在于平衡。肘关节固定过久会迅速变得僵硬，因此我们希望尽早使其活动。然而，正是那根将骨折块拉开的肱三头肌，也是负责伸直肘关节的肌肉。因此，在前六周内，我们通过避免主动伸直来保护修复部位，同时自由地进行肘关节屈曲和前臂旋转练习。待骨骼愈合后，再逐步 reintroduce 伸直动作：首先仅利用手臂自身的重量，仅在更晚阶段才进行抗阻训练。
关于伤口、肿胀及瘢痕管理，请参阅诊所的伤口护理指南。
需提前了解的是，即使鹰嘴骨折固定良好，大多数人最终仍会遗留10–15度完全伸直角度的轻微永久性丧失。这属于正常现象，在日常生活中极少被察觉，并非任何异常迹象。
注意事项与限制
应做
- 佩戴简易吊带以提供舒适与支撑，进行锻炼时取下。无需使用硬质夹板或支具。
- 尽早开始屈曲肘关节及旋转前臂（掌心向上/掌心向下）的锻炼，在舒适范围内进行。
- 保持手部、腕部和肩部的自由活动，并挤压球类以保持握力。
不应做
- 术后前6周内，不要依靠肌肉力量主动伸直肘关节；仅依靠重力使其伸直。主动伸直会牵拉肱三头肌，可能导致骨折端分离。
- 在约3个月且经治疗师许可前，不要进行任何抗阻或负重伸直练习。
- 在早期数周内，不要用患侧手臂提、推或拉物体，也不要通过患肢负重。
以下为您讲义中的锻炼方法，旨在恢复肘关节和前臂的活动度。进行锻炼时请取下吊带。请按照Hirpara医生和治疗师的指导开始锻炼。
您的练习
您的临床治疗方案
本页面其余部分为经切开复位内固定术治疗的鹰嘴骨折的临床治疗方案。本节内容需提供给您的物理治疗师或手治疗师，以下每个阶段均以通俗语言解释当前的治疗情况。本方案与通用肘部骨折方案最显著的区别在于保护肱三头肌：主动伸展推迟至约6周，抗阻伸展推迟至约3个月，因为肱三头肌止于鹰嘴，会对内固定装置产生负荷。
治疗前，请查阅患者的X线片、手术报告及既往病史，并与主治外科医生沟通内固定方式（张力带钢丝 vs 钢板）、固定稳定性及预后情况。
第0–1周：固定
第一周的重点是软组织休息、控制肿胀，并保持其他部位活动。肘部置于简易吊带中，角度约为90°，仅在锻炼时取下。不使用刚性后侧夹板或支具。
致物理治疗师：
- 固定： 简易吊带，肘关节约90°，锻炼时取下（KH补充说明：无后侧夹板或支具）。
- 目标： 软组织休息；水肿控制（抬高、轻柔加压、冷敷）。
- 锻炼： 手部、腕部和肩部的主动活动范围；若内固定稳定，可从第2–3天开始进行轻柔的肘关节和前臂主动活动范围锻炼。
- 注意事项： 上肢不负重；禁止提、推或拉；禁止肘关节主动伸展。
- 进阶标准： 伤口愈合及肿胀消退。
第1–6周：受保护的活动（限制伸直）
此阶段为保护肱三头肌阶段。屈曲活动逐步推进，而伸直仅通过被动方式或重力完成，绝不可利用肘部自身的伸直力量。约在第4周开始逐步停用吊带。
物理治疗师须知：
- 活动度上限： 在无痛张力范围内，屈曲每周大约增加 10°；目标为 第6周时实现完全被动伸直、无痛屈曲至120°以及前臂完全旋转。仅允许被动伸直：禁止主动伸直。
- 练习： 主动及主动辅助性屈曲，加上旋前/旋后；被动活动度练习可从约第4周开始。肩胛带、肩胛周围肌群及前臂肌群仅进行等长收缩，不包括肘部伸直。
- 支具： 在第4周开始逐步停用吊带（此后仅在外出及夜间为舒适起见佩戴）。
- 进阶标准： 完全被动伸直，屈曲至约120°，完全旋转；疼痛评分≤3/10。
第6–12周：引入主动伸展
骨骼愈合六周后，重新引入主动伸直，仅对抗重力，不加额外负重。屈曲活动度逐步进展至全范围，手臂承重也逐步温和增加。
供您物理治疗师参考：
- 目标： 完成活动度范围；引入轻柔的主动伸展。
- 练习： 从第6周开始仅对抗重力的主动肘关节伸展；屈曲进展至全范围（目标在第9周左右达到全范围无张力活动弧）。根据耐受情况，逐步进展承重方式：桌面 → 墙壁 → 四点跪位。可开始渐进性抗阻练习以针对屈曲/旋转，但仍禁止抗阻伸展：此限制维持至3个月。
- 进展标准： 主动活动度全范围；伸直滞后无加重；影像学显示骨愈合。
3–6个月：抗阻伸展与功能恢复
抗阻伸直（这是直接对肱三头肌及修复部位产生负荷的步骤）需待骨折愈合后，方可在此阶段开始。
供您物理治疗师参考：
- 抗阻肘关节伸展从约3个月开始（从弹力带逐步过渡至轻重量，约0.5–2公斤 / 1–5磅，每周3次）。
- 从约4.5个月开始进行针对运动和职业特定需求的训练。
- 提举重物及重体力劳动在力量完全恢复且骨折愈合后恢复，通常在6个月左右。
- 鹰嘴固定术后取出内固定物很常见（尤其是张力带钢丝，这是体内最常取出的植入物），通常在骨折愈合后进行，旨在缓解突出或刺激性的内固定物，而非常规步骤。
重返工作与活动
在遵循上述注意事项的前提下，早期即可进行将手臂置于膝上、双手参与的自我护理等轻度活动，但任何对肘部产生负荷的动作均需等待。通常在约六周时，屈肘和前臂旋转多已感觉舒适；主动伸直从六周开始恢复，并在随后数周内稳步改善。
较重负荷的活动需分阶段进行：约三个月前不进行抗阻或负重伸直训练；约四个半月时开始进行针对运动和工作的专项训练；通常在约六个月时，一旦您的力量和骨骼愈合情况允许，即可恢复提举和重体力劳动。基于办公桌的轻体力工作通常可以更早恢复；请在复查时与Hirpara医生讨论具体恢复时间，因为这取决于您的工作性质以及手术的是哪一侧手臂。当您不再使用悬臂带，并能在复查时确认可以安全地用双臂控制车辆后，即可恢复驾驶。
请注意，伸直末端的10–15度活动度可能会有轻微永久性丧失；这属于正常现象，通常对日常功能无影响。
术后方案
本方案与诊所的一般康复建议配合使用：请参阅术后疼痛管理和伤口护理。关于损伤本身，请参阅鹰嘴骨折。上述分阶段计划与鹰嘴骨折切开复位内固定术（ORIF）后已发表的康复方案一致，您的持续康复将由您的物理治疗师或手治疗师根据您肘部的进展情况个体化指导。
Evidence & references
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
