Elbow treatment
Elbow fracture fixation holds a broken bone in position with plates, screws or wires — but in this joint that is often the straightforward part. The elbow is a tightly fitting hinge whose stability rests on several structures at once, so the operation frequently has to rebuild a stable joint rather than simply fix a bone: repairing or replacing the radial head, securing the coronoid, repairing torn ligaments. And the reason all that matters is movement. This joint stiffens faster than almost any other, so the aim throughout is an elbow solid enough to start moving within days.
A simple, isolated fracture may need nothing more than a plate or wires holding it while it unites. Complex injuries — the fracture-dislocations where the elbow came out of joint and broke on the way — ask considerably more. The radial head props up the outer side of the joint, and where it is shattered beyond reliable repair it is replaced with an implant rather than pieced together, because it is a stabiliser and a poor reconstruction is worse than a good replacement. The coronoid, a small projection at the front, resists the joint sliding backwards and is fixed where it is involved. Torn ligaments are repaired. Occasionally a hinged external frame holds the joint stable enough to be moved while everything heals. All of it exists to serve one purpose: an elbow that can begin moving almost immediately.
Recovery after elbow fracture fixation
This recovery is measured in movement rather than by X-ray. The fracture unites well before the elbow is working properly, and the arc keeps improving for six to twelve months with consistent therapy — which is why the rehabilitation matters as much as the fixation.
Timings describe typical recoveries — a simple fracture and a complex fracture-dislocation behave quite differently, and our specialist will set out which applies to you.
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For most people, yes — and the measure that matters is the arc of movement, not the X-ray. A well-fixed, stable elbow moved early recovers a functional range in the great majority of cases, meaning comfortable use for eating, dressing, working and driving. Restoring the joint surfaces smoothly also protects against wear developing later, which is one of the main arguments for fixing a fracture that runs into the joint rather than accepting a step in the surface.
The honest qualification concerns the last few degrees and the complex injuries. A proportion of people never regain full straightening, which in practice is barely noticed — losing the ability to bend enough to reach your own face is the deficit that genuinely disables, and treatment is aimed at protecting that above all. Complex fracture-dislocations, where the joint came apart and broke, recover more slowly and carry a meaningfully higher chance of some permanent stiffness. Knowing which category your injury falls into shapes what to expect, and it is set out before rather than discovered afterwards.
These are well-established operations, and for the fractures that need them the case is clear. The complication that dominates in this joint is stiffness — which is somewhat pointed, since avoiding it is much of why the surgery is done. It is worked against with stable fixation and early guided movement, and it is the reason the rehabilitation plan is discussed before the operation rather than handed over afterwards.
Beyond that: the ulnar nerve runs immediately behind the joint, so it is identified and protected, and temporary numbness in the little and ring fingers afterwards is not unusual. Extra bone forming in the soft tissues is more common after elbow trauma than at most joints and can restrict rotation; it is watched for, and forcing movement through pain makes it more likely rather than less. Infection is uncommon. And hardware at the point of the elbow is frequently felt through the thin skin there, sometimes warranting removal once the bone has healed.
Movement starts almost immediately; everything else takes months. Guided exercises usually begin within days rather than after the wound has healed, the fracture unites over about three months, and the arc of movement keeps improving for six to twelve with consistent therapy. Light everyday use returns well before strength does, and heavy lifting waits until the bone has united. Complex injuries run slower throughout. Where are you in this?
Start moving as soon as you are cleared, and take that instruction literally. The fixation was chosen to make early movement possible, so waiting until the elbow feels comfortable works against the whole plan. Keep the shoulder, wrist and fingers mobile throughout, elevate to settle swelling, and attend the follow-up imaging that confirms everything has held position.
This is the stretch that decides your final range — steady beats forceful. Consistent guided exercises win movement; aggressive pushing through pain inflames the joint and can encourage extra bone to form. Report a range that is slipping backwards rather than waiting for the next appointment, since stiffness is far easier to treat early than late.
A united fracture in a stiff elbow is a treatable problem, not the finished article. Structured therapy recovers useful range for many people well after the bone has healed. Where movement has genuinely plateaued, releasing the tightened capsule and clearing extra bone or hardware that is in the way is an option worth assessing rather than accepting.
Most people have one operation and are done with it. Where a second is needed, it is usually for one of three predictable reasons rather than because something went wrong.
Hardware removal is the commonest, particularly at the point of the elbow where plates and wires sit under very thin skin and can be felt or catch when leaning on the arm. It is a smaller procedure done once the fracture has fully healed. Stiffness that has not responded to therapy may warrant releasing the tightened capsule and clearing extra bone that has formed. And occasionally a fracture is slow to unite or the fixation loosens, which needs revising. Complex fracture-dislocations carry a higher chance of further surgery than simple fractures, and where that risk applies to your injury it is discussed at the outset rather than left to emerge.
Not every elbow fracture needs fixing. Surgery earns its place in specific situations — check yours:
That is the picture elbow fracture fixation is genuinely for. The assessment establishes what has broken, whether the joint is stable once reduced, and whether the injury is a simple fracture or a fracture-dislocation needing the stabilisers rebuilt — because those recover quite differently. It also confirms whether early movement will be possible, which is the outcome the whole plan is built around.
A stable, well-aligned elbow fracture often heals without surgery. Many undisplaced fractures, including a good number at the radial head, do well with brief protection and early movement — and in this joint, getting it moving matters more than immobilising it. More: elbow fractures & dislocations
And remember: the consultation’s job is the right answer for your fracture — including “no operation.”
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It restores the broken bone to its proper position and holds it there with plates, screws or wires while it heals. But in the elbow that is only part of the job, and often the easier part. This is a closely fitting hinge whose stability depends on several structures at once, so the operation frequently has to rebuild more than the fracture: repairing or replacing the radial head, fixing the small coronoid process at the front, and repairing torn ligaments. The goal is not simply a united bone but a joint stable enough to be moved within days.
Because it is a critical stabiliser, and a poor repair is worse than a good replacement. The radial head props up the outer side of the elbow and resists it levering open, so where it is broken into several pieces that cannot be reliably reconstructed, replacing it with a metal implant restores that support immediately. Attempting to fix a badly shattered radial head can leave fragments that fail, collapse or block rotation. Where the fracture is simple and the pieces are few, fixing it is preferred; where it is not, replacement is the more dependable answer.
Because the elbow stiffens faster than almost any joint, and a bone that healed perfectly inside an elbow that no longer bends is a poor result. Modern fixation is designed to be stable enough to allow guided movement within days rather than weeks, and that early movement is treated as part of the operation rather than as aftercare. It is also why complex injuries are reconstructed thoroughly — restoring stability is what makes early movement safe. Where the elbow is too unstable to move early, a hinged external frame is occasionally used to allow it.
More often here than elsewhere, particularly at the point of the elbow. The olecranon has almost no soft tissue covering it, so plates and wires there can be felt through the skin, catch when you lean on the elbow, and become genuinely irritating. Removal once the fracture has fully healed is a smaller second procedure and is common enough to be worth mentioning before the first operation. Hardware elsewhere around the elbow is usually left in place permanently unless it causes symptoms.
Longer than the bone healing suggests, and measured by movement rather than by X-ray. Guided movement usually begins within days, the fracture typically unites over about three months, and the arc of movement continues improving for six to twelve months with consistent therapy. Most people regain a functional range, though a proportion do not recover the last few degrees of straightening — which matters less in daily life than losing the ability to bend. Complex fracture-dislocations recover more slowly than simple fractures, and carry a higher chance of some permanent stiffness.
Related: elbow fractures & dislocations · loose bodies & elbow stiffness · elbow arthroscopy · all elbow surgery · physiotherapy
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