Elbow Fracture Surgery for Seniors Arnold MO

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Robert A Shively, MD
(314) 652-4100
915 N Grand Ave
Saint Louis, MO
Business
Washington University Orthopedics
Specialties
Orthopedics

Data Provided By:
Sidney Herbert Herr, DDS
(636) 296-6332
937 Jeffco Blvd
Arnold, MO
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
John J Sueme, DDS
(314) 843-5583
9911 Kennerly Rd Ste H
Saint Louis, MO
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
Dale E Doerr
(314) 849-0311
12639 Old Tesson Rd
Saint Louis, MO
Specialty
Orthopedic Surgery

Data Provided By:
Stephen Eugene Vierling, MD
(314) 849-0311
12639 Old Tesson Rd Ste 115
Saint Louis, MO
Specialties
Orthopedics
Gender
Male
Education
Medical School: St Louis Univ Sch Of Med, St Louis Mo 63104
Graduation Year: 1976

Data Provided By:
James G Schaus, DDS
(636) 464-3020
4051 Jeffco Blvd
Arnold, MO
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
George D Bankhead, DDS
(314) 843-5553
3890 S Lindbergh Blvd Ste 115
Saint Louis, MO
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
Paulo Sergio Bicalho, MD
(314) 849-5414
12152 Tesson Ferry Rd
Saint Louis, MO
Specialties
Orthopedics
Gender
Male
Education
Medical School: Finch U Of Hs/Chicago Med Sch, North Chicago Il 60664
Graduation Year: 1993

Data Provided By:
David B Fagan
(314) 849-5414
12152 Tesson Ferry Rd
Saint Louis, MO
Specialty
Orthopedic Surgery

Data Provided By:
Stephen Martin Benz, MD
(314) 849-5414
12152 Tesson Ferry Rd
Saint Louis, MO
Specialties
Orthopedics
Gender
Male
Education
Medical School: St Louis Univ Sch Of Med, St Louis Mo 63104
Graduation Year: 1982

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Update on Surgical Treatment of Elbow Fractures in the Elderly

Fractures of the humerus (upper arm bone) just above the elbow are difficult to treat. Surgery is the standard way to treat these fractures. But the optimal approach isn't always clear at the out set. The surgeon must take into consideration many factors. How did it happen? What kind of break is involved? Are the soft tissues around the bone damaged in any way? Did the elbow joint surface crack in the process? How strong is the bone (i.e., does the patient have osteoporosis or brittle bones)?

The orthopedic surgeons who wrote this article are from the University of Maryland in Baltimore. They offer a review of the latest research in the area of distal humeral fractures. Distal is just another way of saying the break occurred at the bottom end of the bone.

Surgeons are seeing more of these injuries with the aging adult population in America. Most of these fractures occur in older adults with poor bone quality. That's one of the things that really makes surgery so difficult. Conservative (nonoperative) care is possible but only when the fracture is stable and can be immobilized in a cast or splint. That type of fracture isn't as common as the displaced (bones separate), comminuted (many tiny bone fragments) fractures that require surgery.

The surgical choices are usually: 1) internal fixation, 2) external fixation, and 3) total elbow replacement. Each of these choices has its own indications (when to use them), advantages, and disadvantages.

One of the ways surgeons have of evaluating which approach to use is to examine the results from other patients who were treated with one approach versus another. Outcome measures include elbow range-of-motion, return of normal muscle strength, function, bone healing, and quality of life. The joint should be stable yet move freely. Length of time in the hospital and in rehab along with the associated costs might also be factored in. Complications such as infection, poor wound healing, and nonunion (failure of the bone to heal) are recorded. Implant failure (usually from loosening) and revision surgery are two other possible problems that researchers keep track of as a way to evaluate the final results.

By reviewing all of the available research data, the authors were able to summarize what is known about each of these three surgical treatment approaches. Let's take a look at each one separately.

Internal Fixation. Internal fixation refers to an open procedure where the surgeon puts the bones back together and holds them in place with wires, metal plates, and/or screws. This is the most commonly used operation. Many decisions come into play with this approach. The surgeon sizes up the injury and decides how best to get into the joint: from the back of the elbow (posterior or from the sides? If it seems best to make the incision from the side, then which side: medial (side closest to the body) or lateral (side away from the body)?

Studies show that the posterior approach giv...

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