Early Physiotherapy After Surgery for Infected Distal Humerus Nonunion: A Case Report

Abstract

Background: Infected nonunion of distal humerus fractures is a complex condition requiring infection control, stabilization, and rehabilitation to prevent stiffness and functional decline. Evidence regarding early physiotherapy during the acute postoperative phase remains limited.

Objective: To describe the clinical outcomes of early physiotherapy following surgery in a patient with infected distal humerus nonunion.

Methods: This case report involved a 32 year old male who underwent debridement, implant removal, antibiotic bone cement placement, and external fixation. Physiotherapy was initiated on postoperative day 1 and conducted over four sessions during hospitalization. Outcomes included pain using the Numeric Rating Scale (NRS), range of motion (ROM), muscle strength using Manual Muscle Testing (MMT), edema by limb circumference, and functional ability using the Patient Specific Functional Scale (PSFS). Elbow ROM was not assessed during the protective phase.

Results: Active movement pain decreased from 5/10 to 3/10, while passive movement pain decreased from 6/10 to 4/10. Wrist edema reduced from 19 cm to 18 cm. Shoulder ROM improved from 40° to 90°, and wrist ROM increased from 60° to 70°. Muscle strength improved from 3− to 3 at the shoulder and from 3− to 4 at the wrist. PSFS scores improved in finger movement and self care activities.

Conclusion: Early physiotherapy may help reduce pain and edema while preserving upper limb function during the postoperative protective phase in infected distal humerus nonunion.