Elbow joint is a complex joint and hence elbow surgery is considered as one of the most technically demanding and challenging surgery. Surgical accuracy and caution is paramount whilst undertaking elbow surgeries.
Elbow joint is made of three bones, the humerus, radius and ulna.
Elbow fractures occur from trauma like a fall on an outstretched arm, a direct blow to the elbow, or an abnormal twist to the joint beyond its functional limit.
Radial head and neck fractures: Fractures in the head portion of the radius bone are referred to as radial head and neck fractures.
Olecranon fractures: These are the most common elbow fractures, occurring at the bony prominence of the ulna.
Distal humerus fractures: These fractures are common in children and elderly people. Nerves and arteries in the joint may sometimes be injured in these fractures.
Usual presentation includes pain, bruising, stiffness, swelling around the elbow, a popping or cracking sound, numbness or weakness in the arm, wrist and hand, and deformity of the elbow bones.
An X-rays of the joint or/and a CT scan is needed to determine the extent of the injury to the elbow joint and allows surgical planning.
Surgery is indicated in displaced and open fractures / trauma to realign the bones and stabilise the joint with screws, plates, pins and wires.
Surgical treatment is aimed at maximizing early motion and to reduce the risk of stiffness. Strengthening exercises are recommended to improve the range of motion.
The elbow joint is a type of hinge joint. The normal range of bending (flexion) and straightening (extension) is from 0 to 145 degrees, although the range of motion that we work within for daily activities is only from 30 to 130 degrees (functional range). Loss of extension is usually less disabling than loss of same degree of flexion.
Intrinsic / Intra-articular Causes (within elbow joint)
Post-traumatic Osteoarthritis
Primary Osteoarthritis
Rheumatoid
Joint Infection
Malunions
Extrinsic / Extra-articular Causes (outside elbow joint)
Post-traumatic Osteoarthritis
Burns
Heterotopic Ossification
Congenital – arthrogryposis, congenital disloc radial head
The commonest cause of stiffness is after trauma and injury. In fact, some stiffness after an elbow injury is very common. The amount of stiffness is directly related to the degree of initial trauma and the degree of involvement of the joint surfaces.
The ‘Simple’ Stiff Elbow is one that recovers well. The criteria are:
Mild to moderate contracture (<80)
No or minimal prior surgery
No prior ulnar nerve transposition
No or minimal internal fixation in place
No or minimal heterotopic ossification (bone in the muscles)
Normal bony anatomy has been preserved
The aim is to give the patient pain-free, functional and stable elbow. This means 30-130 degrees flexion and 100 degrees of rotation.
Physiotherapyinvolves active motion exercises. Ideally this should be with a physiotherapist who has an interest in upper limb rehabilitation. Close consultation with the surgeon is recommended.
Surgeryis indicated when patients are no longer improving in their original posttraumatic rehabilitation program. At least 6 to 9 months should be allowed for the inflammatory phase of soft tissue healing to resolve.
Arthroscopic release is ideal for stiffness due to arthritis and when there has been no previous surgery. However, if there has been a previous internal fixation and there are extrinsic causes for the stiffness open surgery may be required
Dr. Omkar is excellent Doctor. My 11 year old son fallen down while playing with both fracture wrist. Left hand wrist operation was so critical and 2-3 Doctors refused to do this operation but Dr. Omkar has given us hope and started the operation immediately after admitted my son at the SRV Hospital-Chembur. His study, observation and experience is too good. He is also a very helpful person as human being.
Dr. Omkar Sadigale is very knowledgeable. He diagnosed my wife’s ankle fracture correctly which other doctors could not do. He follows full ethical practices so you are assured that you are in safe hands. I would highly recommend Dr. Omkar Sadigale for any orthopedic or bone surgery related needs.
Best doctor I ever came across! SRV hospital rocks only because they have Dr. Omkar in their hospital as the best orthopedic!! Excellent guidance throughout and for any issues just a call away be it whatever time day or time blessed to have such Dr's whom we trust with our treatments and they don't let us down!
I had a toe fracture as I fell while parking my two wheeler. I was immediately taken to SRV hospital, Chembur under the care and treatment of doctor Omkar Sadigale. Thereafter everything was well handled and taken care by dr.Omkar. There was a small operation conducted on my toe to realign the fractured bones. Now I am fine and able to walk. He is one of the best orthopaedic in Mumbai.
My son has got hip and shoulder fractures due to conversion. I admitted him to SRV Chembur due to RTPCR positive. To be great humanity Dr. Omkar was there at that time in hospital. When I met him at that time I had confidence that I am at the right place. He checked my son and carried operation on the same day afternoon. during the operation, he boosts my morale...Read More
