Introduction
Where non-surgical treatment for elbow instability (due to dislocation or fracture) is not effective, surgery may be recommended. The aim of the procedure is to restore elbow stability and regain full range of motion, reduce pain and restore elbow function.
Preoperative Instructions
- Existing medication(s) – some medications can impact surgery, especially any anti-coagulant medication and medicine for diabetes; we will advise if any of your medication needs to be stopped (and when) well ahead of the day of surgery. Any other medication should be taken the morning of surgery with a little water (half a cup maximum).
- You should not shave (or wax) skin near where any surgical incisions will be made.
- No solid foods (cow's milk and drinks containing cow's milk are considered food) should be consumed within 6 hours of surgery; clear fluids (e.g. water, cordial) may be consumed until 3 hours before surgery and then nil by mouth from that point.
- Please advise us if you have a cold or fever, a cough or any other injuries or infections (e.g. urinary tract infection or cuts/tears to the skin) – your procedure may need to be postponed as any of these may make anaesthesia or surgery unsafe.
- Please bring all imaging (e.g. x-rays / CT scans / MRI scans) with you to hospital.
- Please come to hospital at least one hour before your planned surgery, unless we advise you otherwise.
In very general terms make sure you follow a healthy and balanced diet before surgery and continue any regular physical activity up until the day of the procedure. If you smoke, you should ideally stop smoking at least four weeks before the procedure and otherwise as a minimum at least one week before.
Procedure
The procedure involves the repair of torn ligaments in and around the elbow joint and, where a fracture is present, reducing (i.e. stabilising) it by using pins and / or screws. In some cases where the ligament cannot be repaired, it is replaced by a tendon graft. Occasionally an existing tendon in the wrist is able to be used (the 'palmaris longus' tendon which is present in most people even though it no longer has any function) or one from the back of the knee (hamstring) can also be used.
Access to the elbow is via an incision made to the outside and / or inside of the elbow. Small holes are drilled into the bones and the tendon graft is fixed into these holes where it replaces the lateral ligament's / medial ligament’s function in the elbow. The repair may then be augmented by an internal brace made of suture material. Once the procedure is complete the incision is closed, and the arm is put in a range of motion splint.
Postoperative Instructions
Most patients are able to return home the following day. The splint remains in place for 4-6 weeks during which time light elbow movement is encouraged with a very gradual increase in strength and range of movement exercises. Lifting of anything much heavier than a glass of water should be avoided for the first four weeks after surgery. Most patients can begin driving again 3 months after surgery and return to some sports within a few months. Some sports which put stress on the elbow, such as golf, can be taken up again around 6 months after surgery.
Risks
As with any surgery, with elbow stabilisation surgery there is always a risk of:
- Pain.
- Bleeding.
- Scarring.
- Infection (of the incision site, or in the chest).
- Blood clot (leg or lung).
- Stroke.
- Heart attack.
- Damage to nerves / blood vessels.
Specific risks of elbow stabilisation surgery include:
- Issues with attachment to the bone.
- Recurrence of injury to affected tendon or bones.