Surgical and non-surgical treatment for dislocation of the elbow
Last updated Friday, July 29, 2005
Considering surgeryTypes of surgery recommended
The surgery performed depends on what area is fractured. Typical patterns include the following:
1.
If the radial head (top end of the radius) is fractured, it can be
repaired with small screws, with or without plates. If the fracture is
not repairable, the radial head is replaced with a metallic implant.
2. If the coronoid (top of the ulna in the front of the joint) is fractured, it can be repaired with screws or sutures.
During
these procedures, the ligaments on the lateral part (outside) of the
elbow are repaired. Occasionally, the elbow still remains unstable at
this point and the surgeon will have to repair the medial (inner)
ligaments and even more rarely, will have to apply a hinged external
fixator (pins and bars outside the skin) to provide the necessary joint
stability while the soft tissues heal. This latter procedure is rarely
needed.
Who should consider ?
Patients with residual instability following closed reduction of a
simple dislocation, although rare, will require surgery. Patients with
significant fractures almost always require surgery.
What happens without surgery?
In general, if an elbow remains partially or completely dislocated, the
patient will experience considerable pain, stiffness, decreased
function, and, eventually, arthritis.
Surgical options
The surgery performed depends on what parts of the elbow are fractured. Typical patterns include the following:
1.
If the radial head (top end of the radius) is fractured, it can be
repaired with small screws either with or without plates. If the
fracture is not repairable, the radial head is replaced with a metallic
implant.
2. If the coronoid (top of the ulna in the front of the joint) is fractured, it can be repaired with screws or sutures.
During
these procedures, the ligaments on the lateral part (outside) of the
elbow are repaired. Occasionally, the elbow still remains unstable at
this point and the surgeon will have to repair the medial (inner)
ligaments and even more rarely, will have to apply a hinged. external
fixator (pins and bars outside the skin) to provide the necessary joint
stability. This latter procedure is rarely needed.
Effectiveness
Typically, simple elbow dislocations heal without surgery.
Historically,
complex elbow injuries had poor outcomes. However, with standard
treatment protocols and a better understanding of the injury patterns,
outcomes have significantly improved. Although patients may not regain
a full range of motion, patients can expect to regain a functional
range of motion in their injured elbow. One of the most common
complications of any elbow injury is stiffness. This problem may occur
in both simple and complex injuries. However, with restoration of
stability, range of motion exercises can be started early, decreasing
the risk of residual pain and stiffness.
Urgency
For simple elbow dislocations, the elbow should be reduced as soon as
possible. This is accomplished with adequate sedation and gentle
traction, along with manual realignment of the joint.
Complex
elbow dislocations should also undergo closed reduction as soon as
possible to realign the joint as best as possible. If surgery is
deemed necessary, it should be performed within the first week
following injury before significant scarring and stiffness occurs.
This enables the surgeon to see the injury more clearly during surgery.
Risks
As with any operation, there is risk of infection, possible damage to
nerves, or blood vessels in the surrounding tissue. Despite surgery,
there is also a risk of the elbow remaining unstable or fractures not
healing, although this is not common. There is also risk of stiffness
from scar tissue formation or from extra bone formation within the soft
tissues. Patients should be aware that their elbow will not be like
their other “normal elbow”, but rather the goal is to provide a
functional, pain-free range of motion for daily activities.
Managing risk
All risks in elbow fracture-dislocation surgery do not commonly occur,
however, the most common is continued elbow stiffness. If this occurs,
further surgery, including scar and bone removal may be required to
adequately restore motion.ide a functional, pain-free range of motion
for daily activities.
Surgery for Simple and complex elbow dislocations. at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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