Elbow CPM Following a Stable Intra-Articular Fracture

CPM after a stable fracture has been used extensively in the elbow.9,19,20,21,22,28,30,43,46,48 The initial goal of therapy following a stable fracture is to maintain the range-of-motion. If passive motion is not started within the first 48 hours the prognosis for improvement is significantly diminished.10 O’Driscoll and Giori36 have demonstrated that CPM immediately following a surgical procedure acts to pump blood and edema fluid out of the joint and periarticular tissues. The reduction of these fluids from a synovial joint reduces the risk of post-surgical joint stiffness. A contracted joint typically has an inflammatory component which can be aggravated by the surgical release itself resulting in limited or no improvement in range-of-motion following the surgical procedure. Salter,42 Kim,26 Kroeder27 and Moran34 have all shown that CPM has reparative effects on inflamed joints. However, until recently the mechanism by which CPM acts as an anti-inflammatory agent was unknown. Recent studies by Gassner,17 Lee,29 Xu49 and Ferretti14 have helped explain the molecular basis for the beneficial effects of CPM on the inflamed joint. A CPM device by applying cylic tensile stress on the involved joint for an extended time counteracts the effects of the inflammatory agents even better than immobilization.