Early elbow movement compared to delayed elbow movement after a broken elbow in adults

The elbow plays an important role in any arm movement such as reaching or lifting. A broken bone, commonly referred to as a fracture, in the elbow can result from a simple fall onto an outstretched arm. A fracture may occur in one or more of parts of the three bones that form the elbow joint. These parts are the upper sections of the two forearm bones (the radius and the ulna) and the lower section of the upper arm bone (the humerus). A well-documented problem after an injury to the elbow is elbow stiffness and loss of normal movement. After initial treatment, which may involve surgery for more serious fractures, treatment may involve immediate gentle movement of the elbow, using a sling for support only, or it may involve a period of time resting still in a sling or plaster cast. It is not known which approach results in better movement and function of the elbow after the fracture has healed.

We searched for randomised controlled trials that compared early movement with delayed movement of the elbow after elbow fracture. We included one trial reporting results at times ranging from two to 47 months for 81 people who had had an elbow fracture that involved the head of the radius. The evidence from this trial is of very low quality. The trial found no important differences between early and delayed mobilisation in the numbers of participants with pain or limitations in their range of elbow motion. All participants were reported as being able to use their arms for full activities of daily living and none had changed their occupation or lifestyle. There was no mention of fracture complications.

We concluded that there was a lack of reliable evidence to answer the question of whether early mobilisation improved function without increasing complications in adults with elbow fractures.

Authors' conclusions: 

There is a lack of robust evidence to inform on the timing of mobilisation, and specifically on the use of early mobilisation, after non-surgical or surgical treatment for adults with elbow fractures.

There is a need for high quality, well-reported, adequately powered, randomised controlled trials that compare early versus delayed mobilisation in people with commonly-occurring elbow fractures, treated with or without surgery. Trials should use validated upper limb function scales, and assessment should be both short-term (to monitor recovery and early complications) and long-term (at least one year).

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Background: 

A fall on the outstretched arm can result in an elbow fracture. Loss of elbow function is a common problem with these fractures and can have major implications for functional capabilities. It is unknown whether early mobilisation can improve functional outcome without increasing complications.

Objectives: 

To compare the effects (benefits and harms) of early mobilisation versus delayed mobilisation of the elbow after elbow fractures in adults.

Search strategy: 

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 2), MEDLINE (1950 to August 2010), EMBASE (1980 to August 2010), CINAHL (1982 to June 2010), PEDro (31 May 2010), and ongoing trials registers (April 2010).

Selection criteria: 

We included randomised and quasi-randomised controlled trials evaluating early mobilisation of the elbow joint after elbow fracture in adults.

Data collection and analysis: 

Two authors independently selected trials, assessed risk of bias and extracted data. There was no pooling of data.

Main results: 

We included one trial reporting outcome at follow-up times ranging between two and 47 months for 81 participants with Mason type 1 and 2 radial head fractures. This poorly-reported trial was at particular high risk of detection and reporting biases. The trial found no significant differences between early and delayed mobilisation in the numbers of participants with pain or limitations in their range of elbow motion. All participants were reported as being able to use their arms for full activities of daily living and none had changed their occupation or lifestyle. There was no mention of fracture complications.

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