Post-Surgery Challenges After Distal Humerus Fracture: Recovery Insights

Postoperative issues following distal humeral fracture surgery?

Hello Doctor, I am here to inquire again about my car accident on June 2nd of this year, which resulted in a distal humeral fracture in my left arm.
On June 3rd, I underwent surgery where two metal plates and eight screws were inserted to stabilize my upper arm, and two long bone nails and wires were placed in my elbow and forearm.
In November, I scheduled the removal of one of the bone screws from my ulna.
Currently, I have no issues extending my arm, but my flexion is still about 10-20 degrees less compared to my right arm, and I cannot touch my shoulder.
1.
Recently, I have noticed pain when keeping my elbow straight for extended periods.
Is this related to the weather? It is particularly noticeable in the morning after waking up.
How can I improve this?
2.
My attending physician mentioned during my follow-up in November after suture removal that my recovery is progressing well and that I do not need to return for further visits.
The remaining plates can be removed or left in place, and if I choose to have them removed, I can return in a year.
Since I am still undergoing rehabilitation, the rehabilitation doctor advised that since the plates are foreign objects, it would be better to remove them if I plan to engage in more vigorous or high-impact activities, as this could further improve my elbow flexion.
I would like to know your opinion on this matter.
3.
My attending physician said that I can ride a bike now, but given my current condition, is it really safe for me to do so? I am concerned about whether my bones can withstand the vibrations and pressure from biking and the possibility of re-injury.
4.
Regarding exercise, I am currently trying to support myself with both hands on the table to help my left hand adapt to my body weight (for about 10 seconds), using a resistance band (with my right hand fixed and my left hand pulling up to stretch), and using a grip strengthener multiple times to train my left hand.
Generally speaking, when can I start engaging in aerobic exercises (like boxing aerobics) or strength training (such as planks, dumbbell lifts, or push-ups)?

Celine, 30~39 year old female. Ask Date: 2020/12/29

Dr. Shi Guozheng reply Orthopedics

1.
Apply heat or use pain relievers.
2.
Surgical implantation of a steel plate for distal humeral fracture, as it is very close to the radial nerve, should not be removed unless absolutely necessary.
3.
Activities can be resumed after bone healing.
4.
Weight should be gradually increased; avoid using excessive force all at once to prevent re-fracture.
It is best to wait at least one year before engaging in weight training, etc.

Reply Date: 2020/12/29

More Info

After a distal humerus fracture, the recovery process can be quite challenging, especially following surgical intervention. In your case, where you underwent surgery involving the placement of plates and screws, it is crucial to approach rehabilitation with care and patience. Here are some insights regarding your concerns:
1. Pain in Elbow When Extended: Experiencing pain in the elbow, particularly after prolonged periods of extension, can be influenced by several factors, including weather changes. Many patients report increased joint discomfort during colder or damp weather, which may be due to changes in barometric pressure affecting the joint tissues. To alleviate this discomfort, consider gentle stretching exercises, applying heat before activity, and ensuring proper ergonomics during daily tasks. Additionally, maintaining a regular routine of physical therapy can help manage pain and improve range of motion.

2. Decision on Plate Removal: Your orthopedic surgeon's recommendation regarding the removal of the plates is a common consideration. While the plates can remain in place if they are not causing any issues, their presence can sometimes limit the range of motion, especially during high-intensity activities. If your rehabilitation specialist suggests that removing the plates could enhance your recovery and allow for greater movement, it may be worth discussing this further with your surgeon. Ultimately, the decision should be based on your functional goals, the level of discomfort you experience, and the potential risks involved in surgery.

3. Returning to Cycling: The decision to resume cycling should be approached cautiously. While your surgeon has cleared you to ride, it is essential to assess your comfort level and confidence in your arm's stability. If you feel apprehensive about the potential for re-injury due to vibrations or impacts, it may be wise to start with low-impact activities that do not place excessive strain on your arm. Gradually reintroducing cycling, perhaps starting on a stationary bike, can help you gauge your strength and comfort before transitioning to outdoor cycling.

4. Resuming Aerobic and Strength Training: The timeline for returning to more vigorous activities, such as aerobic exercises or weight training, varies significantly among individuals. Generally, patients can begin light aerobic activities around 3-6 months post-surgery, depending on their recovery progress and pain levels. For strength training, it is advisable to wait until you have regained a significant range of motion and strength in your arm. This could take anywhere from 6 months to a year post-surgery. Always consult with your physical therapist or physician before starting any new exercise regimen to ensure it aligns with your recovery status.

In summary, recovery from a distal humerus fracture involves careful monitoring of pain, gradual reintroduction of activities, and ongoing communication with your healthcare team. It is essential to listen to your body and not rush the process, as this can lead to setbacks. Regular follow-ups with your orthopedic surgeon and physical therapist will help ensure that you are on the right track toward a full recovery.

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