Elbow dislocations are unusual injuries in which the bones forming the elbow joint are traumatically separated. These injuries usually require patients to go to the emergency room to have the elbow reduced (put back in place). After reduction, the arm is placed in a long arm splint and an arm sling. The elbow joint is unusual in that is functions almost purely as a hinge joint and it is normally tightly constrained by the ligaments surrounding the joint. When the elbow dislocates, some or all of the constraining ligaments are damaged. In the worst case, several of the ligaments completely rupture and the elbow remains unstable even in a cast. In evaluating patients with elbow dislocations the initial concern is to determine if the ligaments are partially or completely ruptured and how stable the joint is in a splint or cast. X-rays are helpful to assess the alignment of the joint and a CT scan or an MRI may be necessary to fully assess the injury. In uncomplicated cases, patients remain in a long arm cast or splint for about 2 weeks and then transition to a hinged elbow brace. The most common complication of dislocation long term is joint stiffness and an inability to fully straighten (extend) the elbow.
For non displaced fractures, close observation and casting are the suggested treatment. The downside to conservative management is that the elbow tends to stiffen after even brief periods of immobilization. In adults this can lead to permanent loss of motion so the goal is to begin moving the elbow as soon as possible.
In displaced fractures we recommend surgery to restore the congruence of the joint and provide stability to the triceps anchorage. The procedure typically takes approximately one hour and can be performed on an outpatient basis. The surgical incision is centered on the back of the elbow. The method used to repair the fracture depends on a number of factors including the amount of splintering (comminution) and the quality of the bone. If the fracture is a fairly clean break with two large pieces, a tension band with several wires holding the fracture is usually sufficient.
A plate and screws may be necessary in cases where the bone is very soft or the fracture has multiple fracture lines and comminution. There are several manufacturers who produce custom bent plates for use in the olecranon. Many of these plates offer (locking screws) where the screws thread into the plate and this prevents toggling and loosening. These types of locking plates are ideal for use in patients with softer bone.
After surgery, it is common to be placed in a splint for about two weeks. This allows your arm to swell some but still provides immobility. After the splint is removed, you will begin a fairly aggressive protocol with physical therapy to regain range of motion in the elbow. Recovery is generally fairly quick and most patients regain full function within 8-12 weeks after surgery. Once the fracture has healed, many patients experience irritation from the prominence of implants. If this occurs, removal of the implants approximately 10-12 months after the initial procedure may be necessary.
The primary long term problem that develops after surgery is stiffness of the elbow joint. Most patients are able to bend fairly well but getting the elbow completely straight is often troublesome. Patients should expect to lose 5-10 degrees of extension (ability to completely straighten the arm) the healing process is complete. Unfortunately, surgical release of the scar tissue around the elbow often makes the problem worse. This approach is only indicated in the most severe contractures. A Dynasplint (a dynamic splint worn in part of the time) is a helpful adjunct to help prevent stiffness, in conjunction with physical therapy. This can help patients regain motion more quickly.
For more information about surgery, what to expect after surgery and some useful tips and FAQ’s, take a look at the post-op elbow instruction sheet (link below). If you are scheduled to have surgery on your elbow, you should read this.