Indications:
This procedure is indicated for a number of injuries around the elbow joint. Common indications are for distal humerus (lower arm bone) fractures, olecranon fractures, radial head fractures, other intra-articular fractures of the elbow and forearm bone fractures. The indications for fracture surgery vary with each fracture.
What to expect before surgery
If you are to undergo this procedure with Dr Bala, you will usually consult a member from the anaesthetic team a few hours prior to the surgery. You may be required to bring some of your more recent investigations including a chest x-ray, ECG and routine blood tests and your old x-rays, CT scans or MRI scans. If required the nurse or physician may order more tests if required. The procedure is usually performed under general anaesthesia especially if the surgery may involve taking bone from the waist. It may also be performed under WALANT (Wide Awake Local Anaesthesia No Tourniquet) although indications are limited. The anaesthetist may further discuss these with you. The procedure and anaesthesia are usually for an hour or 2. Most elbow fracture surgeries are day surgery procedures meaning you will usually go home the same day should you be well.
The nurse will instruct you on the time you should start fasting prior to the surgery start time, the reporting time into the hospital and the possible discharge time. It may not be possible to shower the night before surgery but it is advisable to remove jewellery at home.
On the day of surgery
It is good to report a couple of hours prior to the scheduled operation time to enable time for you to change into the hospital gown and be reviewed by the anaesthetist and the surgeon. The only prick you might feel is that of the IV line prior to anaesthesia. A ‘timeout’ is done to ensure that the entire team is satisfied with the side, procedure and equipment. The anaesthetist will give you some sleep medicines 1st to make you comfortable and you may request for your choice of music as drowse off to sleep. You will usually be given automatic calf compressors which massage the calf muscles during the duration of the surgery to prevent blood clots from forming. You will also be given an electrical warming blanket to ensure your body remains warm during the duration of the surgery. Some surgeons prefer to give the WALANT a good half an hour before the scheduled start of the case. An IV antibiotic (usually cefazolin) is administered prior to surgical incision.
Surgery
Anaesthesia is usually given on the operating table. A regular table with attachments to position the patient on his/her side and a radiolucent elbow support used. The procedure maybe done with you either lying on your back or side. Dr Bala prefers the lateral position with an elbow support for many elbow fractures. A commercially available arm holding device (‘Spider’/ ‘Trimano”) maybe required when doing it when the patient lies on his/her back. Once you are comfortably positioned on the operating table with adequate cushioning, a C arm is used to check to see if the fracture is visible. A tourniquet is applied which is like a blood pressure cuff to keep blood out of the field of surgery to help improve visibility of important structures. Then the operating side is cleaned and draped. The upper limb is drained of blood using an elastic band called an Esmarch bandage and the tourniquet is inflated to keep blood out and the procedure is begun. Everyone on the team will be protected against radiation with lead aprons. Dr Bala will ensure the patient is also adequately protected from radiation. Where available Dr Bala prefers to use the mini C-arm or fluoroscopy machine to minimize radiation risks. Once the fracture has been adequately fixed, Dr Bala closes the wounds with absorbable or non-absorbable sutures. There may be wires left outside after the fracture has been fixed. Rarely you may have pins and rods (external fixator) left outside. The operated area is cleaned and a compressive waterproof dressing is applied to soak up the ooze. A partial or complete plaster maybe applied to the elbow after fixation if required. A collar and cuff or arm sling pouch is usually provided to support the elbow after surgery. The drapes are removed and you will be shifted back to the trolley from the operating table after the procedure is complete.
For more details of specific procedures performed you may visit the following pages of this website
Elbow fractures https://pradeepbala.com/conditions-treated/elbow-fractures/
Radial head fractures https://pradeepbala.com/conditions-treated/radial-head-fracture/
Elbow dislocations https://pradeepbala.com/conditions-treated/elbow-dislocation/
Forearm fractures https://pradeepbala.com/conditions-treated/forearm-fracture/
Distal biceps rupture https://pradeepbala.com/conditions-treated/distal-bicepital-tendinitis-distal-biceps-rupture/
Triceps rupture (pls provide link)
After surgery
You are usually kept in the observation bay in the operating theatre for a couple of hours and may either be shifted to the ward or discharged directly from the theatre. Once you are fully awake, have had a few sips of water without throwing up, can move all of your fingers comfortably without pain you may be discharged.
Dr Bala may either phone your closest relative or see you before you are discharged.
Follow up
You will be allowed to allowed to shower a couple from the following day after the surgery ensuring that the plaster remains dry. The physiotherapist will instruct you to as to what movements you can and cannot do after surgery. Dr Bala sees his post op patients at around 2 weeks after surgery. There maybe a few sutures to remove if at all. You may require some intense sessions of physiotherapy after surgery to optimize the function of your elbow and or forearm, wrist and fingers. Dr Bala will review x-rays at 2, 6 and 12 weeks or until union. Wires may need removal at 6 or 12 weeks depending on the condition treated. Plates and screws usually don’t need removal unless the fracture has fully healed and the plate is causing a functional limitation. External fixators usually need removal between 6 to 12 weeks under anaesthesia.