Elbow Surgery: Complications and Recovery After Hardware Removal

Q: Elbow Surgery: Complications and Recovery After Hardware Removal

Hello： In response to your question... Postoperative stiffness of the elbow joint is indeed challenging to manage. The treatment methods are as follows： 1. Active rehabilitation 2. Arthrolysis 3. Gradual use of splints or casting 4. Capsular release and ad

Removal of metal screws

Hello Director Li, I was injured in a car accident last year, resulting in a comminuted fracture of the ulnar olecranon in my right elbow.
After an emergency surgery where steel pins were used for internal fixation, the pins were removed three months later.
This led to nonunion of the olecranon and severe elbow stiffness (from 135 degrees to 75 degrees).
After being referred by a friend, I underwent surgery at Veterans General Hospital, where the doctor indicated that the previous hospital's physician removed the pins too early, causing the bone to not heal properly.
I had to undergo joint reconstruction and bone grafting surgery.
During the surgery, the doctor removed adhesions and bone spurs from the elbow joint and discovered that a piece of cartilage was missing.
I have been following the rehabilitation physician's guidance, attending rehabilitation sessions twice a week for three hours each time, but I have not seen significant improvement; my elbow remains stiff and cannot flex or extend freely (from 155 degrees to 60 degrees).

I have several questions for you, Director Li:
1.
How long will it take to remove the steel pins?
2.
Will not removing the steel pins affect joint mobility?
3.
How can I restore my elbow to its original condition?
4.
Will the missing cartilage regenerate, and will it affect elbow mobility?
5.
Is performing joint mobilization beneficial?
6.
How many sessions of mobilization are necessary?
7.
If the above methods help straighten the elbow as before, what side effects might occur?
8.
Are there any other methods to alleviate joint stiffness and restore my elbow to its original state?
I would greatly appreciate your answers.

MARY, 20~29 year old female. Ask Date: 2005/01/18

Dr. Li Wenlin reply Orthopedics

Hello: In response to your question...
Postoperative stiffness of the elbow joint is indeed challenging to manage.
The treatment methods are as follows: 1.
Active rehabilitation 2.
Arthrolysis 3.
Gradual use of splints or casting 4.
Capsular release and adhesiolysis.
Generally speaking, full extension of the elbow is less critical, but flexion is very important.
Achieving at least 135° of elbow flexion significantly impacts daily life, while extension primarily affects appearance.
Based on your description, removing the internal fixation three months after an olecranon fracture was premature.
The impact of internal fixation on joint function varies by individual case; not every case is affected.
Typically, it is recommended to remove internal fixation at least one year post-surgery, although in rare situations, such as early fixation removal or skin irritation, it may be removed sooner based on the healing status of the fracture.
Articular cartilage does not regenerate, so proper reduction of the joint surface during surgery is paramount.
However, in cases of severely comminuted fractures, sacrificing a small portion of cartilage may be unavoidable.
Postoperatively, diligent rehabilitation is essential.
There are many methods to improve elbow stiffness back to baseline; the best approach is to have a thorough discussion with your attending physician, who can recommend the optimal first step.
Whether the second step of arthrolysis is appropriate and whether to use a cast will depend on the specific circumstances and is not a one-size-fits-all decision.
Please communicate frequently with your attending physician.

Keelung Hospital, Department of Health, Executive Yuan
Li Wen-Lin

Reply Date: 2005/01/18

More Info

Hello, thank you for your detailed inquiry regarding your elbow surgery and recovery process. It sounds like you have been through a challenging journey following your elbow injury, and I appreciate your patience as you navigate these complications. Let’s address your questions one by one, while also providing some context about elbow surgery, complications, and recovery.

1. How long until hardware removal?
Typically, the timing for hardware removal, such as screws or plates, depends on the healing process of the bone. In general, hardware can be removed after the bone has sufficiently healed, which usually takes about 3 to 6 months post-surgery. However, if there are complications like non-union (where the bone does not heal properly), the surgeon may recommend keeping the hardware in place longer to provide stability.

2. Does not removing hardware affect joint mobility?
Leaving hardware in place generally does not affect joint mobility unless it causes irritation or discomfort. In some cases, if the hardware is prominent or if there is a risk of it interfering with joint function, removal may be necessary. However, if the bone has healed well, the presence of hardware should not limit your range of motion.

3. How to restore elbow function?
Restoring elbow function after surgery often involves a combination of physical therapy, stretching, and strengthening exercises. It’s crucial to work closely with a physical therapist who can tailor a rehabilitation program to your specific needs. Gradual, consistent therapy is key to regaining mobility and strength.

4. Can cartilage regenerate?
Unfortunately, cartilage does not regenerate like bone does. When cartilage is damaged, it can lead to joint pain and stiffness. While there are some experimental treatments aimed at promoting cartilage repair, such as stem cell therapy or microfracture techniques, the success of these treatments can vary. The absence of cartilage can indeed affect joint mobility and lead to conditions like osteoarthritis over time.

5. Is joint mobilization surgery advisable?
Joint mobilization surgery can be beneficial for patients with significant stiffness and limited range of motion. This procedure aims to break up adhesions and improve mobility. However, it should be considered after conservative treatments have been exhausted, and the risks and benefits should be thoroughly discussed with your orthopedic surgeon.

6. How many mobilization sessions are needed?
The number of sessions required for joint mobilization can vary widely based on individual circumstances, including the severity of stiffness and the specific techniques used. Your surgeon or physical therapist will be able to provide a more personalized estimate based on your progress.

7. What are the side effects of using a cast to straighten the elbow?
Using a cast to immobilize the elbow can help in certain situations, but it may also lead to muscle atrophy, stiffness, and decreased range of motion if used for extended periods. It’s essential to balance immobilization with appropriate rehabilitation to prevent these side effects.

8. Other methods to reduce stiffness and restore function?
In addition to physical therapy, other methods to improve elbow function may include:
- Heat and cold therapy: Applying heat can relax and loosen tissues, while cold can reduce inflammation.

- Ultrasound therapy: This can help promote healing and reduce stiffness.

- Hydrotherapy: Exercising in water can reduce strain on the joint while allowing for movement.

- Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation.

In conclusion, recovery from elbow surgery, especially after complications like non-union and stiffness, can be a lengthy and challenging process. It’s essential to maintain open communication with your healthcare team, follow their recommendations, and be patient with your recovery journey. Each case is unique, and your healthcare provider will be the best resource for personalized advice and treatment options. Thank you for your questions, and I wish you the best in your recovery!

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