Elbow Issues: Long-Term Effects of Incomplete Treatment

Elbow issues

My mother suffered a fracture of the elbow joint.
After evaluation by the physician, it was determined that either pin fixation or casting would be appropriate.
After discussing with my mother and sister, we decided to proceed with casting due to her advanced age (84).
However, my mother had low compliance; after the cast was applied, the doctor advised her to use a sling, but she frequently let her arm hang down.
After the cast was removed, she did not comply with rehabilitation, resulting in some degree of flexion in her arm.
Four years later, today, a large area of swelling was discovered in her elbow.
She is currently being cared for by my older brother, who took her to the hospital for examination.
My brother informed the physician that the lack of proper treatment at that time led to the current situation.
Over the past four years, there have been no reports of pain or discomfort from my mother, and this condition arose shortly after my brother began caring for her, with the suggestion that it was due to previous inadequate care.
We are quite puzzled, so I would like to ask the physician if such a situation can occur.

Lai Guangyu, 60~69 year old female. Ask Date: 2020/04/16

Dr. Shi Guozheng reply Orthopedics

There have been no reports of pain or discomfort for the past four years.
Based on the assessment, it is likely that the recent symptoms are due to a bruise, impact, or fall, and should not be related to any old fractures.
Currently, if there are no fractures, conservative treatment with heat application for about two to four weeks should suffice, and the bruising will resolve.

Reply Date: 2020/04/16

More Info

When it comes to elbow joint issues, particularly after a fracture, the long-term effects of incomplete treatment can be significant. In your mother's case, the decision to treat her elbow fracture with a cast instead of surgical intervention was made considering her advanced age (84 years old). While this approach can be appropriate in certain situations, it is crucial to understand the potential consequences of inadequate immobilization and rehabilitation.

Firstly, when a fracture is not properly stabilized or if the patient does not adhere to post-treatment protocols, such as wearing a sling or engaging in rehabilitation exercises, it can lead to complications. One of the most common issues is malunion or nonunion of the fracture. Malunion occurs when the bone heals in an incorrect position, leading to deformity, while nonunion refers to the failure of the bone to heal altogether. In your mother's case, the bending of her elbow suggests that malunion may have occurred due to her noncompliance with the treatment plan.

Additionally, the lack of rehabilitation can result in stiffness and decreased range of motion in the joint. After a period of immobilization, the muscles and connective tissues around the joint can become tight and weak, leading to functional limitations. This is often referred to as "frozen elbow" or elbow stiffness, which can be quite debilitating.

The fact that your mother did not report pain or discomfort for four years does not negate the possibility of underlying issues developing. Some patients may not experience pain until the condition progresses significantly. The appearance of a "large scar" or deformity in the elbow after four years could indicate that the joint has undergone changes due to the previous inadequate treatment. Scar tissue can form around the joint, further limiting movement and potentially causing discomfort or pain later on.

It is also important to consider that the aging process itself can complicate recovery from fractures. Older adults often have decreased bone density and muscle mass, which can affect healing and recovery. This means that even if the initial treatment was appropriate, the natural aging process can lead to complications if rehabilitation is not adequately addressed.

In terms of next steps, it is essential for your mother to undergo a thorough evaluation by an orthopedic specialist. They may recommend imaging studies, such as X-rays or an MRI, to assess the current state of the elbow joint and determine the extent of any malunion or other complications. Depending on the findings, treatment options may include physical therapy to improve range of motion and strength, or in some cases, surgical intervention may be necessary to correct the alignment of the bone or to release any tight structures around the joint.

In conclusion, the situation you described is indeed plausible and highlights the importance of adhering to treatment protocols after a fracture, especially in older adults. Incomplete treatment can lead to long-term complications that may not be immediately apparent. It is crucial to seek medical advice promptly to address any issues and to explore appropriate treatment options to improve your mother's quality of life moving forward.

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