Elbow Fractures: Recovery, Nerve Issues, and Surgical Decisions

Radial, ulnar, and olecranon fractures?

Hello Doctor: In March of this year, I was involved in a car accident that resulted in a closed, comminuted fracture of the right elbow, ulna, and radius.
Both the ulna and radius were completely broken into several pieces.
I have surgical incisions over 10 cm on both the inner and outer sides of my right arm, with three plates and screws implanted.
The right hand is my dominant hand, and it is still somewhat swollen.
As the swelling gradually decreases, I have started to experience tingling sensations in my ring finger, which has now spread to my middle finger, and my thumb is also beginning to feel numb.
This is causing me a lot of anxiety.
I have not consulted a Western medicine rehabilitation specialist, as it feels extremely painful.
I have been seeing a traditional Chinese medicine practitioner, attending treatments three times a week for the first three months (acupuncture, electrical therapy, and herbal baths), and I have been following the orthopedic surgeon's rehabilitation instructions.
During my follow-up appointment, the doctor said my rehabilitation results were unexpectedly good, but he was only in Chiayi for support and has since returned to Taipei.
The doctor who is now taking over my case is not the one who performed the surgery.
Should I let him remove the plates, or should I seek out the original surgeon? This new doctor mentioned that the plate from the olecranon could be removed as early as September, but the original surgeon advised me to wait a year for better outcomes.
Whose advice should I follow? What could be causing the numbness in my hand? Will it get better? When can I expect my hand function to return to its pre-injury state?

Ling, 30~39 year old female. Ask Date: 2018/08/18

Dr. Shi Guozheng reply Orthopedics

It is better to remove the bone screws one year after surgery, and finding another physician can also facilitate recovery in approximately 6 to 12 months.

Reply Date: 2018/08/18

More Info

Hello! It sounds like you've been through a very challenging experience with your elbow fractures and the subsequent recovery process. Let's break down your concerns regarding recovery, nerve issues, and surgical decisions.

Understanding Your Condition
You mentioned that you suffered from a closed, comminuted fracture of the olecranon (the bony prominence of the elbow) and both the ulnar and radial bones. This type of injury can lead to significant complications, including nerve damage, which may explain the tingling and numbness you are experiencing in your fingers. The ulnar nerve, which runs along the inner side of the elbow, is particularly susceptible to injury during elbow fractures and surgeries.

Nerve Symptoms
The tingling sensation in your ring finger, middle finger, and thumb could indicate ulnar nerve involvement, especially if the symptoms are localized to the areas innervated by this nerve. It's crucial to monitor these symptoms closely, as they can be a sign of nerve compression or injury. In some cases, nerve symptoms may improve over time as swelling decreases and the nerve heals, but persistent symptoms may require further evaluation.

Recovery Process
You mentioned that you have been following a rehabilitation program that includes acupuncture and electrical therapy, which can be beneficial in managing pain and promoting healing. However, it's essential to ensure that your rehabilitation program is comprehensive and includes physical therapy exercises specifically designed to restore range of motion, strength, and function to your elbow and hand.

Surgical Decisions
Regarding the removal of the plates and screws, this is a common consideration after fracture fixation. The timing of hardware removal can vary based on several factors, including the type of fracture, healing progress, and the presence of any complications. Your original surgeon's recommendation to wait a year before removing the hardware may be based on ensuring optimal healing and stability of the bone. On the other hand, the new surgeon's suggestion to remove the hardware sooner may be based on their assessment of your current condition.

It's important to have a clear discussion with both surgeons about the rationale behind their recommendations. If you feel uncertain, seeking a second opinion from another orthopedic surgeon who specializes in elbow injuries could provide additional insight.

Returning to Function
As for when you can expect to regain full function in your hand, this can vary widely depending on the severity of the injury, the success of your rehabilitation, and your body's healing response. Generally, it can take several months to a year for full recovery from such injuries. Consistent rehabilitation, including strength training and range-of-motion exercises, will be crucial in regaining function.

Conclusion
In summary, your symptoms of numbness and tingling should be monitored closely, and you should discuss them with your healthcare provider. It's essential to follow a structured rehabilitation program and maintain open communication with your medical team regarding surgical decisions. If you feel uncertain about the advice you're receiving, don't hesitate to seek a second opinion. Recovery from such injuries can be a long process, but with the right care and rehabilitation, many patients can return to their pre-injury level of function. Stay positive and proactive in your recovery journey!

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