Elbow Fracture Open Reduction and Internal Fixation

What is elbow fracture open reduction and internal fixation?

Open reduction and internal fixation (ORIF) is a type of surgery used to
stabilize and heal a broken bone. You might need this procedure to treat
your broken elbow.

The elbow joint is a hinge type of joint composed of 3 bones. The humerus
(the upper arm bone) forms the joint with 2 bones of the forearm: the
radius and the ulna. The ulna forms the bony point of the elbow.

Different kinds of injury can damage any of the 3 bones that form the elbow
joint. This is especially common when you fall on an outstretched hand. The
bone may fracture into 2 or more pieces. In certain types of elbow
fractures, your bone has broken, but its pieces still line up correctly. In
other types of fractures (displaced fractures), the injury moves the bone
fragments out of alignment.

If you fracture your elbow, you might need ORIF to bring your bones back
into place and help them heal. During an open reduction,
orthopedic surgeons reposition your bone pieces during surgery, so they are
back in their proper alignment. In a closed reduction, a
doctor physically moves the bones back into place without surgically
exposing the bone.

Internal fixation
refers to the method of physically reconnecting the bones. This might
involve special screws, plates, wires, or nails that the surgeon places
inside the bones to fix them in the correct place. This prevents the bones
from healing abnormally. The entire operation usually takes place while you
are asleep under general anesthesia.

Why might I need an elbow fracture open reduction and internal fixation?

Certain medical conditions may make fracturing your elbow more likely. For
example, osteoporosis increases the risk of elbow fracture in many older
adults.

Not everyone with a fractured elbow needs open reduction and internal
fixation. In fact, most people don’t. If possible, your doctor will treat
your elbow fracture with more conservative treatments, like pain medicine,
splints, and slings.

You probably won’t need ORIF unless there is some reason your fracture
might not heal normally with these conservative treatments. You are likely
to need ORIF if:

• The pieces of your broken bone are significantly out of alignment
• Your broken bone pierced through your skin
• Your bone broke into several pieces

In these cases, ORIF can place your bones back into their proper
configuration. This significantly increases the chance that your bone will
heal properly.

You might need ORIF for a fracture that occurs anywhere in your elbow
joint, including the lower part of your humerus and the upper parts of your
radius or ulna.

What are the risks for an elbow fracture open reduction and internal
fixation?

Most people do very well with ORIF for their elbow fracture. Although rare,
complications can occur. Possible complications include the following:

• Infection
• Bleeding
• Nerve damage
• Joint stiffness (common)
• Joint instability
• Bone misalignment
• Complications from anesthesia
• Broken screws or plates
• Arthritis of the joint (months to years later)

There is also a risk that the fracture won’t heal properly, and you’ll need
a repeat surgery.

Your own risk of complications may vary according to your age, the anatomy
of your elbow fracture, and your other medical conditions. For example,
people with low bone mass or diabetes may be at greater risk of certain
complications. Smokers may also have an increased risk. Ask your doctor
about the risks that most apply to you.

How do I prepare for an elbow fracture open reduction and internal
fixation?

ORIF often takes place as an emergency or urgent procedure. Before your
procedure, a healthcare professional will take your medical history and do
a physical exam. You’ll need an image of your elbow, probably obtained with
an X-ray or magnetic resonance imaging (MRI). Tell your doctor about all
the medicines you take, including over-the-counter ones like aspirin. Also,
let your doctor know the last time you ate.

In some cases, your doctors might do your ORIF a little later. If so, talk
to your doctor about how to prepare for the procedure. Ask whether you
should stop taking any medicines ahead of time, such as blood thinners.
You’ll need to avoid food and drink after midnight the night before your
procedure.

What happens during an elbow fracture open reduction and internal fixation?

Your doctor can help explain the details of your particular surgery. The
details of your surgery will depend on the location and severity of your
injury. An orthopedic surgeon and a team of specialized healthcare
professionals will do the surgery. The whole operation may take a couple of
hours. In general, you can expect the following:

• You will receive general anesthesia, so that you’ll sleep through the
  operation and won’t feel any pain or discomfort during the procedure.
  (Or, you may receive a local anesthesia and a medicine to help you
  relax.)
• A healthcare professional will carefully monitor your vital signs, like
  your heart rate and blood pressure, during the operation. You may have
  a breathing tube inserted down your throat during the operation to help
  you breathe.
• After cleaning the affected area, your surgeon will make an incision
  through the skin and muscle of your elbow. (The specific site may vary
  according to the bone injured.)
• Your surgeon will bring the pieces of your fractured bone or bones back
  into alignment (reduction).
• Next, your surgeon will secure the pieces of the broken bone to each
  other (fixation). To do this, he or she may use
  screws, metal plates, wires, or pins. (Ask what the surgeon will use in
  your case.)
• Your doctor will make any other necessary repairs.
• After the team has secured the bone, your surgeon will surgically close
  the layers of skin and muscle around your elbow.

What happens after an elbow fracture open reduction and internal fixation?

Talk to your doctor about what you can expect after your surgery. You may
have some pain after your procedure, but pain medicine may help decrease
the pain. You should be able to resume a normal diet fairly quickly. You
will probably get an imaging test done, like an X-ray, to make sure the
surgery was successful. Depending on the extent of your injury and your
other medical conditions, you might be able to go home the same day.

For a while after your surgery, you’ll need to keep the arm immobile.
Often, this means you’ll need to wear a splint for several weeks. Make sure
to protect your splint from water. You’ll receive instructions about how
you can move your arm.

Your doctor might give you other instructions about caring for your arm,
like applying ice. Follow all your doctor’s instructions carefully. Your
doctor might not want you to take certain over-the-counter medicines for
pain, because some of these can interfere with bone healing. Your doctor
may advise you to eat a diet high in calcium and vitamin D as your bone
heals.

You might see some fluid draining from your incision. This is normal. Let
your doctor know right away if:

• You see an increase in redness, swelling, or draining from your
  incision
• You have a high fever or chills
• You have severe pain in your arm
• You have a loss of feeling in the arm or hand

Make sure to keep all of your follow-up appointments. You may need to have
your stitches or staples removed a week or so after your surgery.

At some point, you may need physical therapy to restore strength and
flexibility to your muscles. Doing your exercises as prescribed can improve
your recovery. Most people are able to return to most of their normal
activities within a few months.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications
  are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or
  problems
• How much will you have to pay for the test or procedure

Treatment After an Elbow Fracture

The elbow can be vulnerable to injury. A fracture can result from a fall onto an outstretched arm, a twisting injury to the arm, or from direct trauma. An elbow fracture can cause severe pain and make movement extremely difficult. Treatment for an elbow fracture can vary and depends on the severity and exact location of the injury.

The Elbow Joint

The elbow is a complicated joint made up of three bones, the humerus (upper arm bone) and the ulna and radius (the bones in the forearm). The olecranon is part of the ulna and is the tip of the elbow, and the radial head is the end of the radius where it meets the elbow. The elbow is also made up of ligaments, muscles, and tendons, allowing the bones to move both forwards and backwards as well as rotate in a twisting motion.

Symptoms of A Fracture

The following symptoms can indicate a fracture:

• Sudden, intense pain (especially with movement)
• Swelling
• Bruising
• Stiffness
• Limited range of movement (difficulty bending/straightening the elbow, inability to turn the forearm)
• Tender to the touch
• Visible deformity
• Numbness/tingling/weakness in the arm, wrist, and hand
• Joint instability

If you injure your elbow or experience any of these symptoms, you should seek prompt medical treatment from an orthopedist, as delaying treatment can lead to further damage.

Diagnosing A Fracture

Diagnostic imaging, such as an X-ray or CT scan, is required to confirm if a fracture is present and the exact location of it. It is also used to identify the severity of the damage, whether any bones are misaligned or displaced (when there is a gap between the bones), and to assess whether there are any bone fragments present.

There are different types of elbow fractures, which include:

• Radial head and neck fractures (often occur as a result of a dislocated elbow, or falling on to an outstretched arm).
• Olecranon fractures (from falling directly on the elbow).
• Distal humerus fracture (more common in children and the elderly).

Treatment for Fractures

Treatment largely depends on the severity of the fracture and whether any of the bones have moved during the break, are misaligned, or have pierced the skin. The main goal of treatment is to align the fractured bones to allow new bone formation, correct healing, and to repair any other trauma.

Simple fractures are those that have not pierced the skin, are not misaligned, and are at low risk of moving out of place. They are typically treated with non-surgical methods. This includes immobilization, such as wearing a cast, splint, or sling until the bone heals, and rest, followed by a gentle and gradual increase in motion. Pain relief and anti-inflammatory medication may also help to alleviate symptoms.

For more serious and complex fractures, such as when the bone is out of place or unstable, surgery is often required to realign or stabilize the bones to ensure they heal correctly. Surgical hardware, including pins, metal plates, rods, and screws, may be required to hold the fractured bones together during the healing process.

Surgery may be necessary to remove any loose bone fragments and to repair any soft tissue damage. If any bones have been crushed or severely damaged, a bone graft may be required to fill in the gaps. If damage is severe, the surgeon may need to remove part of the bone, such as the radial head, and replace it with an artificial one to improve function and mobility.

After surgery, once bones have been properly aligned, a splint or cast will be applied. A splint may be used for the first few days to accommodate swelling, with a cast then applied when the swelling has reduced.

Rehabilitation

Even simple fractures can result in some loss of elbow extension. Elbow stiffness is also much more common in adult patients. Rehabilitation, including physical therapy and occupational therapy, is often recommended to help restore and maximize range of motion, reduce and avoid stiffness in the joint, and help you perform activities of daily living, such as getting dressed.

Rehabilitation is also recommended following fracture surgery to speed up recovery, increase strength and mobility, and reduce risk of future injuries. Physical therapy for an elbow fracture may include a number of modalities, including therapeutic exercises, manual therapies such as massage and joint mobilization, ice and heat therapies, ultrasound, and electrical stimulation.

Fracture Care in San Antonio, Texas

If you are experiencing elbow pain, speak to the experienced physicians at the Center for Orthopaedic Surgery and Sports Medicine. We provide prompt diagnosis and treatment for a variety of orthopedic conditions and injuries, including fractures, and are dedicated to providing you with the best patient-centered care available.

For more information or to schedule an appointment, call us at (210) 692-7400.  Alternatively, you can fill out our online form.

Radial head fracture | orthoped-klinik.com

• What causes a fracture of the head of the radius?
• What symptoms are associated with a fracture of the head of the radius?
• What complications can occur after a fracture of the radial head?
• Treatment: how does the elbow specialist treat?

The complex elbow joint is formed by three bones: the humerus is connected to the ulna and radius of the forearm. All three elements are surrounded by a fibrous capsule. © Gelenk Clinic

A fracture of the head of the radius is an injury to the area near the elbow joint. This injury is one of the most common pathologies of the elbow joint in adults. The fracture occurs when the patient falls on an outstretched, slightly bent arm. Less often, a fracture of the radial head occurs during a direct fall or elbow strike.

Injuries to the head of the radius can result in:

• simple
• offset or
• comminuted fractures
• misalignment

In the case of complex fractures, the orthopedist must expect the occurrence of concomitant injuries of the joint capsule and ligaments, which in turn affects the further treatment and recovery time of the patient.

The usual symptoms of this pathology are pain in the elbow, as well as swelling on the outside of the elbow. In addition, the mobility of the elbow joint is limited.

The head of the radius is an important element of the elbow joint. Its rotation around its axis provides pronation and supination of the forearm.

In case of poor healing, the risk of arthrosis and prolonged pain

Before prescribing treatment, it is necessary to take into account the features of the fracture and associated damage to the ligamentous elements of the joint. Thus, our specialists will be able to prevent complications and negative consequences that may appear after unsuccessful healing. Incorrectly healed fractures can permanently limit the patient’s mobility and lead to instability of the elbow joint. Elbow stiffness, premature wear (arthrosis), or death (necrosis) are possible options for a malunion fracture.

Injuries of this nature should be treated in a specialized clinic by specialists in the treatment of diseases of the elbow joint. Only then will you be able to avoid serious consequences. Doctors of the orthopedic medical center Gelenk-Clinic will be happy to answer all your questions.

Causes of fracture of the radial head

A typical injury with a fracture of the head of the radius: a fall on an outstretched, slightly bent arm on the palm. © Halfpoint, Adobe Stock

Often this injury occurs during falls with an outstretched arm in a slightly bent position, if the victim tries to rest his palm on the floor. The forearm is slightly turned inward.

Thus, a sharp massive force is exerted on the elbow joint through the hand and outstretched arm. The head of the radius collides with the massive end of the shoulder, which leads to a fracture. In this case, the injury occurs through indirect force effects.

The more the elbow is stretched during a fall, the more likely it is to damage the head of the radius. Trauma can occur in any age group regardless of gender, although the average age of patients with this pathology is 40 years. People who are actively involved in sports suffer from this more often.

What are the symptoms of a fracture of the head of the radius?

• Pressing pain in the injured area of ​​the elbow
• Pain on the outside of the elbow radiating to the hand
• Redness, swelling and bruising
• Limited mobility of the elbow joint, pain during rotation and extension of the forearm

Typical complaints with a fracture are pain and swelling on the outside of the elbow joint. Pronation and supination of the forearm is limited. As a rule, severe pain and the impossibility of full flexion and extension of the joint. © Sentello, Adobe Stock

Pressure on the damaged head of the radius causes severe local pain. Rotating movements of the forearm in and out, as well as flexion of the elbow, are possible only in the case of a willingness to endure pain. If swelling and bruising appear during a fracture, you may have injuries to the joint capsules and ligaments.

Often, such injuries are associated with hemorrhages in the joints, which further limits their mobility. Displaced fractures (dislocation) can completely stop the mobility of the elbow joint. As a result of a fall, other bone structures, such as the humerus and ulna, can also be damaged.

Nerve injuries are very rare – even in the most difficult cases. Damage to the radial nerve causes sensory disturbances in the arm. In addition, the original functions of the forearm may be impaired.

What injuries are associated with fractures of the head of the radius?

With fractures of the head of the radius, approximately every third patient notices additional damage to the ligamentous apparatus or bone structures.

• Often the external ligament that strengthens the articular capsule of the elbow is damaged
• Potential for injury to other lateral ligaments – annular ligament and joint capsule
• The strong, connective tissue membrane that connects the ulna and radius can also be affected
• Wrist bones can break on impact

Radial head fracture is not a purely bony injury. Very often, the patient also has ligament injuries, which must be paid attention to during the initial diagnosis and further therapy.

How can the head of the radius break?

Radial head fractures are classified according to Mason’s formula. There are four types of fractures. The classification takes into account the number of fragments, as well as the degree of their displacement (dislocation). Based on these criteria, doctors determine the degree of damage to the elbow joint.

Classification of fractures according to the Mason formula. Type 1: not displaced, no more than 2 mm displaced. Type 2: The bone fragment is displaced by more than 2 cm. Type 3: Comminuted. Type 4: Fracture and dislocation of the elbow. © Gelenk Clinic

What complications can occur after a fracture of the radial head?

Late or improper treatment of this pathology may lead to certain complications that will have a negative impact on the daily life and quality of life of the patient.

Complications after fracture of the radial head:

• Limited mobility: this element of the elbow joint is important during the rotational movements of the forearm. Incorrectly fused fractures form steps in the joint, which makes perfect mobility impossible. Bone as well as cartilage fragments can get stuck in the joint space and thus completely block the internal and external rotation of the forearm.
• Elbow Stiffness: The growths and scars from the healing process and the thickened joint capsule limit the function of the elbow joint. Longer immobilization of the elbow in flexion with a cast may limit the extension of the arm at the elbow.
• Chronic instability of the elbow: If the ligaments and tendons do not heal properly, the joint becomes unstable. Chronic epicondylitis (tennis elbow) is sometimes caused by unstable ligaments from previous injuries.
• Osteoarthritis of the elbow joint: Suboptimally fused fractures accelerate the process of cartilage wear in the elbow joint. Thus, premature wear begins, often several years after the injury.
• Necrosis of the head of the radius due to circulatory disorders: especially after comminuted fractures, the blood vessels that feed the bone can be damaged. Often this can provoke death, i.e. necrosis of the head of the radius.
• Injuries associated with unknown collateral injuries: The causes of trauma to the humerus and radius or fracture of the wrist sometimes remain undiagnosed.

Treatment: how does a specialist at the Gelenk Clinic in Germany treat a fracture?

Our many years of experience in the treatment of these pathologies allows us to carry out the therapy appropriate to the stage of the disease. At the same time, we necessarily take into account the individual requirements of the patient, as well as the nature of the underlying damage, including possible concomitant diseases and thus the expected prognosis of conservative and surgical treatment. Elbow specialists will provide you with an optimal consultation and develop an individual treatment plan.

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Surgical treatment

Multi-comminuted, displaced and malunion fractures require surgical intervention. The volume of surgical procedures depends on the degree of deformity. The orthopedic specialists at the Gelenk Klinik Gundelfingen can restore the original position of the joint during surgery.

1. Reconstruction with special screws and plates

Osteosynthesis with a plate and screws: Treatment of a fracture of the radial head. © Gelenk Clinic

Fractures with a displacement of more than 2mm (Type 2 according to the Mason formula) are usually treated with special screws and microplates. This intervention is called osteosynthesis and is minimally invasive.

The displaced bone fragment returns to its original position, where it is fixed. So the surgeon prevents the formation of steps on the articular surface. Used screws and plates do not need to be removed. They can be used to treat associated ligament injuries.

2. Reconstruction of the head of the radius with plates with angular stability

Treatment of a patient with a multi-comminuted fracture (Type 3) after a fall from a mountain bike: Combined osteosynthesis with angular stability plates. X-ray shows the state of the joint after healing. © Gelenk Clinic

Even complex fractures with several fragments and dislocations can be treated with osteosynthesis. To do this, the Gelenk Clinic uses special plates with angular stability, which securely fix individual fragments of the joint

3.

Irreparable fractures: placement of an endoprosthesis

Complications of the prosthesis of the radius, fixed from the outside: the radius with the prosthesis turned out to be longer than it was before. © Gelenk Clinic

In case of multicomminuted fractures of the head of the radius, its reconstruction is impossible. In this case, it is worth thinking about implanting a prosthesis.

From a medical point of view, this intervention is quite complex. The diameter of the prosthesis should match the original size of the head of the radius. Also, the prosthesis should not protrude noticeably in relation to the joint area. This phenomenon is called “Overstuffing” and should be avoided at all costs. Only in this way can the patient avoid pain, accompanied by limited mobility and increased wear of the articular cartilage in the elbow.

With a stable ligamentous apparatus on the inside of the joint, removal of the radial head can be performed without the need for a prosthesis. In this case, the body produces a cartilaginous scar replacement on the neck of the radius. This intervention is rather an exception.

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Our team

* we aim to provide the highest quality care

Bessarab Maksim Sergeevich

• Ph.
• Specialist in arthroscopic and minimally invasive joint surgery and foot surgery
• Dr. Bessarab masters all conservative
  and surgical methods for the treatment of sports injuries
• Performs over 500 arthroscopic procedures per year

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Charchyan Artak Mikhailovich

• Traumatologist-orthopedist of the highest category
• PhD
• Head of a department in a large city hospital in Moscow
• A well-known Russian specialist in joint arthroplasty, as well as the treatment of bone fractures using low-traumatic methods
• Dr. Charchyan performs over 400 high-tech surgeries per year

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Krasnov Genrikh Olegovich

• Traumatologist-orthopedist
• Member of the Association of Orthopedic Traumatologists of Russia and the Russian Arthroscopic Society
• Proficient in conservative and surgical treatment of joints
• Orthopedic insoles specialist, shock wave therapy
• Performs up to 300 arthroscopic procedures per year

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• Traumatologist-orthopedist Bessarab M.