![]() ![]() Special considerations should be made for fractures in children and the elderly. These injuries are very complex and typically require multiple plates to stabilize the broken bones. Distal humerus fractures often involve the joint and will require surgery, which involves repairing the fracture with plates and screws. This bone contains the entire joint surface of the elbow. These fractures involve the portion of the humerus closest to the elbow joint. Complex fractures may also involve ligament injuries that need to be surgically repaired. Some more complicated fractures may require replacing the radial head with a metal implant if there are too many bony pieces. Complex fractures often require surgery with screws or a plate. Simple fractures can be treated with a brief period of immobilization with a splint or sling followed by moving the elbow to pain tolerance. The treatment for this fracture depends on the number and size of the bone fragments. The pain associated with these fractures is present on the outside (lateral) portion of the elbow and usually worse with forearm rotation. The radial head and neck, which are closest to the elbow, are important for rotation of the forearm (twisting from palm up to palm down). Radial head and neck fractures (see Figure 2) The main types of fractures are included below. In some severe cases, multiple bones may be broken at the same time. The location of the fractured bone is important to identify as this will determine the proper treatment and rehabilitation. The humerus starts at the shoulder, and the end (distal) part of it is in the elbow. ![]() The ulna also spans from the elbow to the wrist, but the head is in the wrist, and the cup-shaped part in the elbow is called the olecranon. The radius spans the length of the forearm from the wrist to the elbow, and the head and neck of the radius bone are inside the elbow joint. On the image to the right, you can see plates have been applied to the humerus and the olecranon has been wired back on after utilising an osteotomy to access the joint.There are three main bones in the elbow (see Figure 1): the humerus, the radius, and the ulna. Some stiffness is unfortunately inevitable. Early movement is aimed at preventing excessive stiffness of the joint. It is then time to start moving the elbow through a gentle range of movement. Normally you will be allowed free from both plaster and dressings at that stage and you could get the wound wet. At that point you will see a member of the surgical team in outpatients and have the plaster removed and the wound checked. You will be in a plaster cast supporting the elbow and this will usually remain for 2 weeks. It usually heals without any problem.Īfter the surgery you will remain in hospital for at least one night. This gives very good access to the joint and then after the plates are applied the olecranon is reattached, often using metal wires in a ‘tension band’ technique. This is where the olecranon (tip of the ulna) is carefully broken-away and lifted off. In order to access the very end of the bone, sometimes an olecranon osteotomy is required. The muscles are moved to one side and plates are applied to the bone to hold the pieces in position while they heal. The surgery involves a general anaesthetic and an incision (cut) down the back of the arm from about mid-way down the arm to just beyond the elbow. ![]() For anyone with even moderate demand from the elbow joint, ORIF (fixation with a plate) is recommended. The problem is this will heal in a poor position and the lead to very limited function at the elbow joint. The point at which the shaft changes to being a flat plate is a weak point and so the bone tends to break here. If the patient is quite elderly and frail with low demand and high risks of anaesthesia, the fracture can be managed in a plaster. ![]() If you imagine the end of the humerus to be shaped like the end of a spade, where there is a round shaft that becomes a flat plate. Old or young, if you fall onto the elbow there is a possibility of fracturing the end of the bone into several pieces. The end of the humerus furthest from your head is called the distal end and this forms a joint with the forearm, at the elbow. ![]()
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