ORIGINAL ARTICLE

The Effectiveness of Physiotherapy After Operative Treatment of Supracondylar Humeral Fractures in Children
Peter Keppler, MD,* Khaled Salem, MSc,† Birte Schwarting, MD,* and Lothar Kinzl, MD*Abstract: The indications for physiotherapy after supracondylar
humeral fractures in children are not clear in the literature, even in the presence of an active or passive limitation of elbow joint motion. The authors thereforeperformed a prospective randomized study to assess the effectiveness of physiotherapy in improving the elbow range of motion after such fractures. The authors studied two groups of 21 and 22 children with supracondylarhumeral fractures Felsenreich types II and III, all without associated neurovascular deficits. All children were treated by open reduction and internal fixation with Kirschner wires inserted from the radial side of the humerus.Postoperative follow-up at 12 and 18 weeks showed a significantly better elbow range of motion in the group with weekly physiotherapy, but there was no difference in elbow motion after 1 year. In each group, one child had anextension deficit of 15 or 20 degrees. The authors conclude that postoperative physiotherapy is unnecessary in children with supracondylar humeral fractures without associated neurovascular injuries. Key Words:physiotherapy, supracondylar humeral fractures, range of motion, elbow stiffness (J Pediatr Orthop 2005;25:314–316)

third of all centers prescribe PT after supracondylar humeral fractures (personal communications). The advances inhealth care in the direction of evidencebased medicine have influenced not only doctors but also physiotherapists, with evidence for the effectiveness of PT shifting more to the foreground. We conducted this study to assesswhether PT is appropriate in improving the postoperative elbow range of motion (ROM) after supracondylar humeral fractures in children as it does in adults.

PATIENTS AND METHODS
In a prospective randomized [continua]

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