Fisioterapia

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 passivelimitation of elbow joint motion. The authors therefore performed 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 supracondylar humeral fractures Felsenreich types II and III, all without associated neurovascular deficits. All children were treated by openreduction 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 an extension deficit of 15 or 20 degrees. The authors conclude that postoperativephysiotherapy 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 in health care in the direction ofevidencebased 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 assess whether 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 studybetween January 1994 and December 1998, the active range of elbow flexion and extension in 51 children with supracondylar humeral fractures was determined using the neutral-zero method. The inclusion criteria for joining the study were age between 5 and 12 years, an isolated supracondylar humeral fracture Felsenreich type II or III, open reduction of the fracture and fixation using radially insertedcriss-cross Kirschner wires, as well as consent to join the study4,5 (Figs. 1, 2). The exclusion criteria were closed reduction and percutaneous pinning of the fracture, multiple injuries, postoperative neurologic deficit, fractures with associated vascular or neurologic injury, and failure to keep to the study protocol. After being accepted into the study, randomization was done using a SoftwareExcel Version 3.0 (Microsoft)-generated randomization plan. After 4 to 5 weeks of casting, the Kirschner wires were removed, and the children were followed in weeks 6 to 7, 12 to 13, and 18 to 19 after surgery as well as after 1 year by different examiners so that the examiner did not know to which randomization group the child belonged. Thirty-minute PT sessions were prescribed two or three timesa week. Passive joint and soft tissue stretching techniques as well as active exercises after the Sherrington principles were applied by physiotherapists.6 All exercises were modified so that the playing component predominates. Because most patients visited a local therapist, the regularity of the exercise program was determined and the patient’s compliance was checked at every follow-up visit. Thefirst group (without PT) consisted of 24 children. Because of a late prescription of PT by a family doctor, three children were excluded from the study. The second group (with PT) consisted of 27 children; of them, 5 were not considered for evaluation because of noncompliance with the study protocol. The age and sex distribution as well as the fracture types was
J Pediatr Orthop  Volume 25,...