Treatment of Elbow Fracture-Dislocations

The elbow joint is formed by three bones: the bottom of the humerus (upper arm bone), radius, and ulna. The radius and ulna are two bones in the forearm.

The joint is surrounded by a capsule that integrates with the ligaments. Muscles and tendons attach around the joint as well. Injury or trauma that results in elbow fracture and dislocation affects all of these structures. Loss of stability and function can lead to serious disability.

In this article, common patterns of elbow fracture-dislocation are reviewed. These include anterior (forward) or posterior (backward) dislocation with fracture of any (or all) of the three bones. Detailed description of the anatomy affected is provided.

Simple dislocations can be treated with closed reduction. This means the dislocated elbow is manipulated (moved) back into place. But the more complex fracture-dislocations require surgical reduction. Once the elbow is reduced, then the fracture is repaired. Any other soft tissue damage is also repaired.

The surgeon must decide how to repair each individual type of injury. Radial head injuries can be tricky. It may be necessary to use a pin or wires to hold the pieces of bone together until they heal. Normal movement of the radial head is needed for forearm rotation. This is what gives us the ability to turn the palm up and palm down.

If fracture of the radial head is severe with ligament damage, then it may be necessary to replace it. In the past, the radial head was removed. New understanding has led surgeons to fix or replace it instead. The authors describe their surgical approach to each of the complex fracture-dislocations possible. Before and after X-rays are shown.

Rehab is begun as soon as possible. There may be a delay of a week-to-10 days if the repair is unstable. Early motion can be started with a hinged elbow fixator. The surgeon applies this device. A pin is centered in the joint but the rest of the fixator is outside the arm. The main goal is to allow joint motion while protecting the healing ligaments.

Even with good operative procedure, there can be complications with these complex elbow injuries. Instability and stiffness with loss of motion and function can occur. Heterotropic ossification (bone growth in the soft tissues) and arthrosis (joint damage) are other problems that can develop.

Problems that persist over time that can't be improved with rehab may require an elbow replacement. Older adults who are less active do well with this option. Replacement may not be such a desirable approach in younger patients. Further reconstructive surgery may be tried first instead.

References: Asif M. Ilyas, MD, and Jesse B. Jupiter, MD. The Pathoanatomy of Elbow Fracture-Dislocations: A Road Map to Treatment. In The Journal of Musculoskeletal Medicine. February 2008. Vol. 25. No. 2. Pp. 53-62.