Integrated Physical Therapy in a Unique Case of Holstein-Lewis Fracture With Radial Palsy: A Case Report

TL;DR

This case report details the successful physical therapy and rehabilitation of a young man with a rare Holstein-Lewis fracture and radial nerve palsy.

Contribution

The paper presents a novel, tailored rehabilitation approach using functional physical therapy and a robotic glove for post-ORIF recovery.

Findings

The patient showed significant improvement in pain, strength, and range of motion after rehabilitation.

Use of a robotic glove and functional therapy accelerated recovery of wrist function and daily living activities.

Outcome measures like DASH and PRWE scores demonstrated measurable functional improvements.

Abstract

The term "Holstein-Lewis fracture" describes a spiral fracture that occurs in the shaft of the humerus at its distal third, which has been linked to radial nerve palsy in adults, and operative treatment is the preferred method of treating the trapped nerve at the fracture site. This paper describes a clinical case involving a 20-year-old male patient demonstrating a humeral fracture syndrome accompanied by complications associated with radial nerve palsy. After the necessary investigation, he was diagnosed with a Holstein-Lewis fracture with radial nerve paralysis; he underwent open reduction internal fixation (ORIF), after which he was referred to physical therapy. Developing a successful postoperative rehabilitation program that consists mostly of functional physical therapy interventions is essential for the treatment of this condition. Outcome measures like the Numerical Pain Rating Scale (NPRS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Patient-Rated Wrist Evaluation (PRWE) score were recorded before and after rehabilitation, and pain reduction, improvement in strength, range of motion (ROM), grip strength, and activities of daily living (ADL) were found. The purpose of this case report is to present a comprehensive treatment plan that includes ROM exercises, cryotherapy, and strengthening of grip using a robotic glove for a patient who had a wrist drop and underwent ORIF surgery. This tailored intervention was effective in speeding up the return of functional abilities and improving function in ADLs.

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