Elbow Fracture Surgery for Seniors Sequim WA

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James Paul Zettas, MD
777 N 5th Ave Ste 101
Sequim, WA
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Il Coll Of Med, Chicago Il 60680
Graduation Year: 1955

Data Provided By:
Norman Wahl, DDS
Sequim, WA
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
William J Medlicott, MD FACS
(360) 385-6755
1510 Monroe St
Port Townsend, WA
Gender
Male
Education
Medical School: Univ Washington
Graduation Year: 1959

Data Provided By:
Heidi C Brandt, DDS
(360) 385-9700
1119 Lawrence St
Port Townsend, WA
Specialties
Orthodontics/Dentofacial Orthopedics

Data Provided By:
Alan G Greenwald
(360) 344-0400
834 Sheridan St
Port Townsend, WA
Specialty
Orthopedic Surgery

Data Provided By:
Robert E Stack, MD FACS
(360) 683-1315
2855 E Sequim Bay Rd
Sequim, WA
Gender
Male
Education
Medical School: Pennsylvania
Graduation Year: 1957

Data Provided By:
Mark Thomas Reis, MD
(360) 385-5635
1274 7th St Ste A
Port Townsend, WA
Specialties
Orthopedics
Gender
Male
Education
Medical School: Northwestern Univ Med Sch, Chicago Il 60611
Graduation Year: 1986

Data Provided By:
Tristan M McGovern
(360) 344-3090
834 Sheridan St
Port Townsend, WA
Specialty
Orthopedic Surgery, Sports Medicine

Data Provided By:
David Stafford Whitney, MD
(360) 379-8822
1045 Quincy St
Port Townsend, WA
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Wa Sch Of Med, Seattle Wa 98195
Graduation Year: 1967

Data Provided By:
Louis D Philipp, MD FACS
(360) 683-2309
1291 Stampede Dr
Sequim, WA
Gender
Male
Education
Medical School: Wisconsin
Graduation Year: 1953

Data Provided By:
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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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