Fractures around the elbow, in children, can often be treated with a manipulation and insertion of smooth wires or pins to hold the fracture alignment. In adults however, elbow fractures can be more difficult to deal with.
Elbow fractures can involve several different components of the elbow joint. Fractures of the radial head are approached through a small incision on the outside of the elbow. The fractures are usually held with compression screws that are buried within the bone.
Olecranon fractures
Olecranon fractures involve displacement of the point of the elbow which forms part of the hinge mechanism. These fractures require accurate reduction (resetting) to prevent abnormal wear and tear on the joint surface.
Modern fixation methods involve using low-profile plates along each side of the olecranon to hold fixation. Once the fracture is stabilised and plated, patients are usually able to start movement at an early stage and this reduces the risk of stiffness.
Distal humeral fractures
Distal humeral fractures can be more difficult to treat. These fractures require an incision along the back of the elbow. When the joint surface has been involved, the olecranon, or the point of the elbow, has to be cut free to gain access to the joint.
The fractures are reduced and held with the contoured plates. The plates are made from high grade titanium.
Procedure
Open reduction and internal fixation of an elbow fracture is performed under a general anaesthetic. Intravenous antibiotics are given to reduce the risk of infection. The surgery is performed with a tourniquet in place to prevent blood loss.
The ulnar nerve passes along the side of the elbow and needs to be protected. The nerve is usually released from its normal pathway to allow access to the fracture. Once all of the fracture fragments have been keyed into place, plates and screws are applied to capture the bone fragments and provide stability.
X-rays are taken in theatre to make sure that the joint surface is reduced adequately and that the metalwork is correctly positioned.
The wounds are closed with nylon stitches or sometimes staples which will need to be taken out at the two-week stage. A plaster of paris slab is applied to keep the elbow still in the early recovery phase for comfort.
Post-operative Care
Depending on the degree of stability with the fixation, the aim is usually to start some early movement exercises with the joint. Stiffness can be a major issue following any elbow injury and it may take many months before the elbow reaches its final range of movement. Extensive physiotherapy will be required.
Risks
The risks of surgery include the potential for infection and also the potential for swelling around the ulnar nerve which can result in some altered sensation.