Elbow Fractures

Hand
  • Carpal Tunnel Syndrome
  • Cubital Tunnel Syndrome
  • Trigger Finger/Trigger Thumb
  • Basilar Thumb Arthritis
  • Finger Arthritis
  • Rheumatoid Arthritis
  • Dupytren’s Contracture
  • Tendon Lacerations
  • Tetraplegic Reconstruction

    Wrist
  • DeQuervain’s Tendinitis
  • Wrist Ganglion
  • Distal Radius Fractures
  • Scaphoid Fractures
  • Triangular Fibrocartilage Tear
  • Wrist Arthritis

    Elbow
  • Tennis Elbow
  • Distal Biceps Tendon Tear
  • Elbow Fractures
  • Elbow Ligament Injuries
  • Elbow Arthritis

    Shoulder
  • Rotator Cuff Tendinosis
  • Rotator Cuff Tear
  • Shoulder Instability/Dislocations
  • SLAP Lesions


    • Olecranon fracture fixed with a plate
    Olecranon fracture fixed with a plate

    Olecranon Fractures:Isolated displaced fractures of the olecranon are usually fairly straightforward injuries that require surgical fixation. I believe that plate fixation is best for most olecranon fractures. Early motion can usually be started and these fractures usually do very well following surgical fixation.


    A coronoid fracture fixed with a plate
    A coronoid fracture fixed with a plate

    Coronoid Fractures: Coronoid fractures are usually associated with other elbow fractures and ligament injuries. The can be an important part of very serious elbow injuries, such as the ‘terrible triad’ injury, which involves fractures of the coronoid, radial head, and a tear of the lateral collateral ligament. These and other complex injury patterns usually require operative fixation to have the best chance of future function. I have extensive experience with these injuries, and most patients I’ve treated have had very good outcomes. If the coronoid fracture is small it is usually fixed by suture. If it’s large, it is usually fixed with a special plate; sometimes a screw is added for additional stability.


    A radial head fracture fixed with a plate
    A radial head fracture fixed with a plate

    Radial head fractures: Radial head fractures vary from being minimally-displaced fractures that are treated without surgery, to intermediate severity fractures that require surgical fixation, to fractures that are so bad that they can’t be fixed, or that won’t heal if fixed, that need to be replaced with a metal radial head.

    Even non-displaced radial head fractures can lead to significant elbow stiffness and loss of forearm rotation. Any splinting should be discontinued within 4-5 days and early motion begun. Otherwise, permanent stiffness may result. In order to facilitate motion, the blood clot inside the joint can be aspirated to decrease the internal pressure and make it easier to move the elbow. This is analogous to letting some water out of a water balloon to make it easier to bend.

    If the radial head fracture is displaced and in only 2 or 3 pieces, it is often best to fix it with screws or a plate. These fractures are often associated with other fractures about the elbow especially coronoid fractures, and ligament injuries about the elbow that may also require fixation. They may even be associated with injuries to the wrist. A thorough physical examination can help identify these associated injuries.


    A metal radial head replacement
    A metal radial head replacement

    Radial head fractures that split the head into 4 or more pieces do better with replacement. These metal replacements help provide stability about the elbow to allow any associated ligament injuries to heal correctly. For either radial head fracture fixation or replacement, it’s best to start early motion, within a week, to minimize stiffness. Certain ligament injury patterns will require special post-surgical protocols that are best performed by experienced therapists. That’s why I may get very picky about which therapist I send certain patients to after surgery – not all therapists have the knowledge and experience to optimally rehabilitate these injuries while avoiding stressing the repaired structures.