Elbow ORIF
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What’s the Problem?
Your elbow joint is commonly injured either by falling or in a traumatic accident. In some cases, a plaster is sufficient for treatment, but in others (depending on your overall health and activity, as well as the pattern in which your elbow has broken), then surgery is recommended.
How can you treat it?
In some instances, non-surgical treatment is appropriate. This includes:
- Taking pain relief
- A plaster around the elbow – usually for 6 weeks
- Physio to mobilise the elbow and surrounding muscles/tendons after the plaster has been removed
Ultimately, surgery is only reserved for patients whose injury is severe enough that they would have symptoms of severe elbow pain, stiffness and immobility without it.
The Operation
An elbow ORIF involves an incision around the elbow – usually one but sometimes two. The broken fragments of bone are then manipulated back in place, and plates and screws or wires used to hold them in place.
Sometimes, the radial head (the circular bone at the top of the radius) is too fragmented for plates and screws to hold together, and so it can be replaced with a pyrocarbon replacement (arthroplasty). Some of the nerves to the hand (particularly the ulnar nerve) travel very closely to the bones of the elbow joint and so releasing this is also important in protecting its future function.
The Anaesthetic
You will be asleep for the duration of the operation (ie a general anaesthetic). The anaesthetist may talk to you about a nerve block before the operation, which helps with pain relief and generally lasts 24-48 hours. Alternatively, Mr Lau can put local anaesthetic into the wound whilst you are asleep, which can also help reduce pain.
What are the Risks of this Operation?
- Infection:
Usually only a superficial wound infection to the top-most layer of the skin. In rarer cases a deep infection can develop and this is a serious complication that may require further surgery and exchange of the implants. Rare but serious, <1%. - Stiffness and ongoing pain:
It is common to have stiffness for a few months after the operation. This is because your elbow needs to be splinted to allow the bone to heal. Physio after surgery will help with improving movement, but some elbow rehabilitation will be required. Occasionally, the stiffness may be secondary to metal plate, and a second operation may be required to remove it. - Damage to the nerves and blood vessels around the elbow.
Rare but serious, <1% - Ulnar nerve irritation:
The ulnar nerve controls most of the movement in the hand. Often during the operation it is released and sometimes moved so that it does not come under compression. This can lead to some numbness to the little finger side of the hand, though this improves with time. - Metalware Removal:
Ideally, the metal plates and screws stay inside your elbow for life. In some cases, however, the metalware may become irritable to you with movement. If this occurs, the plates and screws can be removed once the fracture has healed – usually at least 6 to 12 months after the first operation. This is a day procedure and no rehabilitation is required.
Benefits
If Mr Lau recommends surgical fixation of your elbow fracture, it is because he feels you will have a better outcome with surgery. In particular, your elbow will be more pain free, have a greater range of motion and have greater functional improvements than if it was treated non surgically.
What can I expect?
You will wake up with your arm in a sling after your surgery and in a half-plaster. If you have had a nerve block, you shouldn’t feel any pain till the next day. The nurses will provide you pain relief and the next morning a physio will see you to go through some exercises you can do to mobilise the fingers and wrist to prevent excessive stiffness in these joints. These exercises will change over the next few weeks to months but you should try to do them regularly to maximise your rehabilitation.
Most patients spend 1 day in hospital after surgery, before going home. A number of allied health staff (physios, occupational therapists) will make sure you have adequate support at home before discharge. An appointment will be made for you for a wound check at 2 weeks. At this time, the plaster will be removed and you should just need to be in a sling. Another appointment with Mr Lau will be at 6 weeks with repeat XRs
What should I avoid doing?
- In the first 2 weeks:
Keep your plaster/wound dry. Try to mobilise your fingers and wrist as much as possible - Between 2 and 6 weeks:
Your arm will be in a sling, which you can gradually use less and less. Gentle flexion and extension of the elbow is possible, as well as continued wrist/finger exercises. You can pick up lighter objects such as a phone or cup with the affected side. You will have physio or hand therapy to help you with rehabilitation - Between 6 and 12 weeks:
Full mobilisation of the wrist, fingers and elbow. The only restriction is no heavy lifting (weights, heavy pots/pans etc) till after 12 weeks. You shouldn’t need a sling any longer
Return to…?
- Work
Depends what you do. Desk based work can be done from 2 weeks post operatively, if you can do these tasks single handedly. Otherwise generally 6 weeks before you can use both hands freely whilst seated.
For manual work, it depends on what kind of lifting/pushing you do, but generally not before 3 months - Drive
In Australia, you can’t drive unless you are in full control of both your arms. Therefore, whilst you’re in a sling, you cannot drive. Generally 6 weeks post operatively. - Sports/Hobbies:
- Gentle swimming: after 6 weeks
- Gardening (light tasks only): 8-12 weeks
- Bowls: after 3 months
- Golf, tennis, badminton, squash: after 4-6 months
- Weights: commence after 3 months
Concerns or questions?
If you have any concerns post operatively, or you would like further information, please contact Mr Lau through the VBJS on 03 5752 5020 or via email at admin@vbjs.com.au
If you need urgent medical help, call 000 or go to your nearest emergency department.
Rehabilitation protocol
These notes have been prepared by Mr Simon Lau. They are general overviews and information aimed for use by his patients. They reflect Mr Lau’s views, opinions and recommendations. They do not constitute medical advice. The contents are provided for information and education purposes only. Please seek Mr Lau’s specific advice with any questions regarding medical conditions and treatment.