No, not all elbow fractures require surgery. Whether or not surgery is necessary will depend on the location of the fracture.
There are a couple of common locations that are often injured when people fracture their elbows, and the treatment algorithms differ depending on the specific fracture pattern.
It’s really important to appropriately identify the fracture and then move forward with treatment based on an accurate evaluation.
A very simple fracture, such as a radial head fracture, is normally treated conservatively with early range of motion exercises as long as there are no mechanical blocks to motion and the joint is stable.
Occasionally, the radial head has a more significant fracture or there’s a block or impingement to motion as a result of the fracture. Then it’s either treated with open reduction internal fixation to put it back together or with a radial head replacement to restore elbow function.
Fractures of the olecranon are challenging to treat conservatively because of how the triceps tendon attaches. Depending on the severity of the fracture, elbow function and arm strength could be significantly compromised. So, most olecranon fractures are treated operatively.
Distal humerus fractures have a wide range of treatment options. Some will heal with non-operative management using a splint and sling. If the fracture involves a significant amount of the joint surface, it may need open reduction fixation with plates and screws.
In a few cases, if the fracture is not able to be put back together or managed appropriately with lesser intervention, a total elbow replacement may be necessary.
As with any fracture that requires surgical intervention, the sooner the better in most scenarios. We aim to get patients in the operating room within a couple of weeks.
If we wait longer, we find a lot of callus formation, which is from the body attempting to heal the bone on its own. If the bone is in a bad position and we have to realign it, that callus can get in the way. We have to remove the callus to free up those fracture fragments so we can place them where they need to be to fix the elbow.
This is easiest to accomplish within two weeks of the injury.
Elbow surgery typically takes between one to two hours, depending on the fracture pattern. In some complex fracture scenarios, it could take longer.
Patients should expect the complete healing process to take between 4 to 6 months.
Directly after surgery, the elbow will need to be immobilized. Then we’ll transition to a hinged elbow brace as soon as possible. The benefit of the hinged brace is that it allows us to protect the range of motion while preventing as much stiffness as possible. This allows the bone to heal without compromising the repair.
We’ll start range of motion exercises as soon as the patient is able to. These will be non-weight bearing immediately after surgery. Then as the bone starts to heal, we’ll add in some light activities.
The hardest part for most patients is regaining their range of motion in the elbow, which makes the recovery from elbow surgery a bit longer than other surgery locations.
Most patients have their elbow feeling like normal at around 4 to 6 months.