![]() ![]() In many instances the plates cause irritation as they sit directly under the skin and next to the nerve that supplies sensation to the ring finger and index finger. Waiting lessens the chances of recurrence. In some cases removal of the ectopic bone is necessary but not until 6-8 months after the injury. This is most common with severe injuries or in patients with concomitant closed head injury. In some cases this stiffness can be severe and is caused by ectopic bone formation (bone forming in places where it usually does not occur) along the front capsule of the elbow joint. For more information about Dynasplints, click on the link below. Most insurance plans will allow for a 3 month lease of the splints. A dynamic elbow splint applies gentle force to straighten or bend the elbow and patients can adjust the degree and amount of force to their own tolerance. Even with aggressive rehabilitation, most patients have some loss of motion in the involved elbow that is most noticable in extension (straightening the elbow). The most common long term complications are joint stiffness, heterotopic bone formation and painful retained hardware or pain over the plates. Total recovery time can take 6 months and most patients have very good range of motion and strength after the bone heals. Post-operatively, patients wear a splint (soft cast) for a short period of time and then begin a fairly aggressive protocol with physical therapy to regain range of motion in the elbow. After surgical repair, patients are able to begin moving their arm within 2 weeks of the surgery and the risk of long term stiffness is reduced. In most cases this is temporary but can take several months to resolve. Neuropraxia is a condition in which the nerve ( (ulnar nerve))that runs along the back part of the elbow (funny bone) is irritated and does not work properly after surgery. The most common complications of the surgery are infection (about 2%), stiffness (10%) and nerve injury called neuropraxia (about 2-3%). The surgery takes approximately 2 hours and most patients stay overnight in the hospital. Surgery involves re-aligning the fracture and holding the repair with plates and screws. Surgery is warranted with the joint surface has 2mm of displacement or more. It is very important to ensure that the surface of the cartilage is repaired as accurately as possible. If the surface is incongruent because the bones are not aligned, chronic damage to the joint occurs, ultimately leading to arthritis. Typically the surface of the joint is smooth allowing the bones to glide past one another with very little friction. These fractures typically involve the surface of the joint (cartilage). However, prolonged elbow immobilization leads to significant and lasting stiffness in the joint. A small percentage of these fractures can be treated in a long arm cast. ![]() Although children tend to have quite a bit of anxiety about having the pins removed, it is essentially painless and does not warrant the risk of additional anesthesia.ĭistal humerus fractures in adults usually warrant surgical repair. ![]() The pins are generally removed in clinic after 4 weeks and the cast discontinued altogether after about 6 weeks. Most children stay overnight in the hospital and are discharged the next day. In rare instances, an incision is necessary to visualize the fracture. Treatment involves aligning the bones under x-ray (Fluoroscopy) and holding them in place with pins placed through the skin (percutaneous) into the bone. There is usually an obvious deformity of the arm with rapid swelling. ![]() Unlike fractures in adults, these are usually a hyper-extension injury. Supra-condylar humerus fractures are common in children and classically occur from falling off the monkey bars. In most cases these fractures are unstable and require some type of internal fixation to prevent them from healing in a bad position. In addition, the treatment of these fractures in children is different than treatment in adults. There are two main groups: Those that involve the joint surface (intra-articular fractures) and those that do not involve the joint surface (extra-articular fractures). Fractures of the distal humerus (Elbow) result from a fall on the elbow with the arm in a flexed position. ![]()
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