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I was out playing softball with my adult children. I tried to slide into home plate and score the winning run, but at my age (52 years old), it didn't go so well. I broke both my elbows. The bigger problem is that I have had rheumatoid arthritis since I was a young kid. Neither one of those elbows were in very good shape to begin with. The surgeon is trying to decide what type of surgery would be best for me. What do you advise?

An elbow fracture in someone with rheumatoid arthritis (RA) is a bad break. Surgery is often needed. There are two basic choices: open reduction and internal fixation (ORIF) or total elbow replacement (TER). ORIF involves using a metal plate, wires, and/or screws to hold the broken bone(s) together. Plates and screws are referred to as instrumentation. A recent report from the Mayo Clinic offered some thoughts on the treatment of patients such as yourself. The authors made note of the fact that elbow deformity caused by the arthritis and age-related osteoporosis of the bones make surgical management difficult. They studied a series of 16 elbows with similar injuries to your own. They found that ORIF works well for patients with mild arthritis. But joint replacement is usually needed for patients with severe arthritis. The decision as to which procedure to use was based on X-ray findings, strength of the bone, and patient preferences. Whenever possible, the surgeons tried to use ORIF because it preserves the joint and is a less invasive procedure. In some cases, when both elbows are involved, surgery may be ORIF on one side and total joint replacement on the other side. Your surgeon will be able to advise you based on all things considered. The final decision may be made during the operation. Once the surgeon gets inside the joint and sees the extent of damage from the fracture and deformity from the arthritis, the most appropriate choice for you may be very clear.

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