Joint Stiffness After Elbow Fracture Surgery - Orthopedics

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After an elbow fracture surgery, particularly one involving internal fixation with plates or screws, it is not uncommon for patients to experience joint stiffness. This stiffness can be attributed to several factors, including the nature of the injury, the surgical procedure itself, and the subsequent immobilization of the joint during the healing process.

In your case, the severe stiffness you are experiencing, with a flexion angle of less than 40 degrees, is concerning. Typically, after elbow surgery, patients are encouraged to begin gentle range-of-motion exercises as soon as it is safe to do so, often within a few days post-operation. However, if there was significant swelling, pain, or if the healing process was not progressing as expected, the initiation of rehabilitation might have been delayed.

The early removal of the internal fixation device, such as the steel pins or plates, can sometimes lead to complications if the bone has not fully healed. If the bone fragments have not united properly, this could contribute to stiffness and limited range of motion. However, it’s essential to understand that stiffness can also occur even when the bone is healing correctly, due to the formation of scar tissue or joint capsule tightness.

Regarding your question about whether general anesthesia could be used to manipulate the joint, this is sometimes referred to as "manipulation under anesthesia" (MUA). This procedure can help restore range of motion by breaking up adhesions and scar tissue that may have formed around the joint. However, it is not without risks. Manipulation can lead to further injury, including the potential for fracture or damage to the surrounding soft tissues. Additionally, there is a risk of heterotopic ossification, where bone forms in soft tissue, which can further complicate recovery and lead to increased stiffness.

In terms of treatment options, rehabilitation is indeed the primary approach to address joint stiffness. A physical therapist can guide you through a structured program that may include:
1. Passive Range of Motion Exercises: Initially, these exercises can be performed by a therapist or a caregiver to help move the joint without the patient actively engaging the muscles.

2. Active Range of Motion Exercises: As healing progresses, you will be encouraged to actively move the joint through its range of motion.

3. Strengthening Exercises: Once you regain some motion, strengthening exercises will be introduced to improve muscle support around the joint.

4. Modalities: Techniques such as heat, ice, ultrasound, or electrical stimulation may be used to reduce pain and swelling, making it easier to perform exercises.

5. Joint Mobilization Techniques: A skilled therapist may use specific techniques to mobilize the joint and improve range of motion.

If conservative measures do not yield satisfactory results, further interventions may be considered, such as arthroscopic surgery to release tight structures around the joint or to remove any obstructive scar tissue.

In conclusion, while the early removal of the steel pins may have contributed to your current stiffness, it is essential to work closely with your orthopedic surgeon and physical therapist to develop a comprehensive rehabilitation plan. They can assess your specific situation, monitor your progress, and adjust your treatment as necessary to help you regain function in your elbow. Always communicate any concerns or changes in your condition to your healthcare team to ensure the best possible outcome.