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Our Mum is a spry 77-year-old but she fell yesterday and broke her elbow. She's been seen by a team of experts but no one can decide which treatment is best for her: operate to fix the fracture or replace the elbow. They are bringing in one more expert to take a look today. Why is this such a difficult decision?
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When it comes to treating elbow fractures in the elderly, surgeons are indeed faced by many factors and the difficulty of technically challenging procedures. If they perform an open reduction and internal fixation (ORIF) procedure (open incision, hardware to hold the broken bones together), there is the risk that the bones won't knit together, infection, and stiffness. In addition, sometimes the bones still drift apart resulting in loss of reduction. Patients end up with painful arthritis and elbow deformities that affect the use of that arm.
But if the surgeon replaces the joint with a total elbow arthroplasty (TEA) or joint replacement, then the risks are for loosening of the implant, infection, and fractures around the implant. Either way the the factors affecting the decision are complex making the treatment decision difficult.
The main advantage of ORIF is that it can be successful leaving the natural anatomy and bone intact. Should the procedure fail to reduce pain, increase motion, and improve function, then it is still possible to have a joint replacement later.
There is also some suggestion that comorbidities (other health problems present at the same time) might influence the results. Alcoholism, rheumatoid arthritis, chronic obstructive pulmonary disease (COPD), diabetes, heart disease, and osteoporosis (brittle bones) are just some of the common problems among older adults. There is some evidence to suggest that patients with comorbidities are more likely to have better results with total elbow arthroplasty (TEA). But whether the presence of any comorbidity (or only certain conditions) makes a difference remains unknown.
So you can see just some of the reasons why the treatment decision for your Mum requires a team of experts. There may be other factors specific to your mother's case that are important. Don't hesitate to ask the case manager or even the surgeon in charge just exactly what their thinking is in your mother's case and to explain the final treatment choice that is made.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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