Urgent Inquiry: Managing Elbow Stiffness After Fracture Surgery

Q: Urgent Inquiry: Managing Elbow Stiffness After Fracture Surgery

Hello： It is recommended that you visit our orthopedic department for further examination, as we need to assess the actual condition in order to provide an accurate diagnosis.

Urgent inquiry?

Hello Doctor, my friend had a severe car accident on November 6th last year, resulting in a comminuted fracture of the elbow.
He underwent surgery on November 6th, with internal fixation using steel pins.
Less than six months later, he discovered that his elbow had significant stiffness, with a range of motion of less than 60 degrees (flexion at 65 degrees and extension at 110 degrees).
During a follow-up visit, the surgeon mentioned that the fracture had not fully healed and advised him to undergo rehabilitation.
However, upon visiting another hospital, other physicians recommended immediate removal of the pins, warning that otherwise, adhesions could form, leading to permanent stiffness and disability of the elbow joint.

I would like to ask the following questions:
1.
If the pins are removed immediately, will the unhealed fracture at the olecranon heal completely on its own?
2.
If the pins are not removed, will the stiffness of the elbow worsen over time?
3.
How long should he wait before the pins can be removed?
Thank you for your guidance.

Feng, 10~19 year old female. Ask Date: 2007/05/10

Dr. Wang Zikang reply Orthopedics

Hello: It is recommended that you visit our orthopedic department for further examination, as we need to assess the actual condition in order to provide an accurate diagnosis.

Reply Date: 2007/05/10

More Info

In managing elbow stiffness after a fracture surgery, particularly in the case of a comminuted fracture with internal fixation using screws, it is crucial to understand the implications of both surgical intervention and rehabilitation. Your friend's situation, where the elbow has developed significant stiffness with limited range of motion, raises several important considerations.

1. Immediate Removal of Screws: If the screws are removed before the fracture has fully healed, there is a risk that the bone may not heal properly. The healing process typically requires stability, which the screws provide. Removing them prematurely could lead to incomplete healing, resulting in a non-union or malunion of the fracture. This could ultimately compromise the structural integrity of the elbow joint and lead to further complications. Therefore, it is essential to assess the healing status through imaging studies, such as X-rays, before making a decision about removing the screws.

2. Consequences of Not Removing Screws: If the screws are not removed and the elbow remains stiff, there is a risk that the stiffness could worsen over time. Adhesions can form within the joint, leading to a condition known as arthrofibrosis, which can significantly limit motion and may require more invasive treatments, such as manipulation under anesthesia or even surgical release. The longer the joint remains stiff, the more difficult it may become to regain full range of motion. Therefore, it is essential to engage in a structured rehabilitation program that focuses on gradually improving flexibility and strength.

3. Timing for Screw Removal: The timing for screw removal typically depends on the healing process of the bone. Generally, screws are left in place for at least 6 to 12 months after surgery, depending on the fracture type and the patient's healing response. If the bone is not healing adequately, the orthopedic surgeon may recommend a different approach, such as further imaging or even a revision surgery. It is crucial to have regular follow-ups with the orthopedic surgeon to monitor the healing process and to make informed decisions regarding the removal of the screws.

In addition to these considerations, it is essential for your friend to engage in a comprehensive rehabilitation program. This program should include:
- Physical Therapy: A physical therapist can design a tailored rehabilitation program that focuses on improving range of motion, strength, and function. Techniques such as passive and active stretching, strengthening exercises, and modalities like ultrasound or electrical stimulation may be beneficial.

- Gradual Progression: It is important to gradually increase the intensity and duration of rehabilitation exercises. This helps to avoid exacerbating pain or stiffness while promoting healing.

- Pain Management: Managing pain effectively is crucial for participation in rehabilitation. This may include medications, ice therapy, or other modalities as recommended by the healthcare provider.

- Monitoring Progress: Regular assessments of range of motion and function should be conducted to track progress and make necessary adjustments to the rehabilitation plan.

In conclusion, your friend's situation requires careful consideration of the healing status of the elbow joint and the potential risks associated with premature screw removal. Engaging in a structured rehabilitation program under the guidance of healthcare professionals is essential for optimizing recovery and regaining function. Regular follow-ups with the orthopedic surgeon will help ensure that the healing process is on track and that any necessary interventions can be made in a timely manner.

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