ORIF, Radial Head Fracture: Internal fixation using micro-fragment (20/24 mm) screws or low-profile plates

Q1. What is an ORIF of a radial head fracture?

ORIF stands for Open Reduction and Internal Fixation. It is a surgical procedure used to repair a broken radial head—the knobby end of the outer forearm bone (radius) at the elbow. "Open reduction" means the surgeon makes an incision to realign the bones, and "internal fixation" means using hardware (like plates and screws) to hold the bone pieces together in their proper positions while they heal.

Q2. What are micro-fragment screws and low-profile plates?

These are specialized, tiny surgical implants designed specifically for the delicate bones of the elbow. Micro-fragment screws (often 2.0 or 2.4 millimeters in diameter) are extremely small screws used to secure bone fragments. Low-profile plates are ultra-thin metal plates designed to sit flat against the bone surface. Because the skin and muscles around the elbow are very thin, these low-profile implants provide strong stability without irritating the surrounding tissues or causing stiffness.

Q3. Why do I need surgery instead of just a cast or sling?

While minor or non-displaced fractures can be treated with a sling, surgery is necessary when the bone pieces have moved out of place (displaced), are broken into multiple pieces (comminuted), or block the normal rotation of your forearm. Realigning these fragments surgically restores the joint surface, prevents long-term arthritis, and allows you to start moving your elbow sooner to avoid permanent stiffness.

Q4. How should I prepare for my surgery?

Preparing for surgery involves several key steps:

• Follow all fasting instructions (no food or drink) provided by the hospital.
• Arrange for a responsible adult to drive you home and stay with you for the first 24 hours.
• Wear loose-fitting clothing with wide sleeves that can easily fit over a bulky elbow bandage or splint.
• Review your current medications with Dr. Veillette's team, especially blood thinners, to know which ones to stop before surgery.

Q5. What type of anesthesia is used during this procedure?

Most patients receive a combination of general anesthesia (which puts you to sleep) and a regional nerve block. The nerve block involves injecting numbing medication near the nerves around your shoulder or collarbone. This block numbs your entire arm, providing excellent pain relief for 12 to 24 hours after surgery and reducing the need for heavy pain medications.

Q6. What happens during the ORIF surgical procedure?

During the surgery, Dr. Veillette will make an incision on the outside of your elbow to access the broken radial head. The bone fragments are carefully aligned back into their normal anatomical positions. Once the fragments are in place, they are secured using micro-fragment screws, a low-profile plate, or a combination of both. The incision is closed with sutures, and a sterile dressing and splint are applied.

Q7. Will I need to wear a splint, cast, or brace after surgery?

Yes. Immediately after surgery, your elbow will be placed in a bulky, padded splint to protect the repair and keep your arm comfortable. This splint is typically worn for the first 1 to 2 weeks until your first follow-up appointment. Depending on the stability of the fracture repair, you may transition to a removable elbow brace that allows controlled motion, or you may be allowed to begin gentle movement right away.

Q8. How can I manage my pain after the procedure?

Managing pain effectively requires a multi-faceted approach:

• Take prescribed pain medications exactly as directed, especially before the regional nerve block wears off.
• Elevate your elbow above the level of your heart using pillows to reduce swelling.
• Apply ice packs wrapped in a towel to the elbow for 15-20 minutes at a time, several times a day.
• Transition to over-the-counter pain relievers like acetaminophen or ibuprofen as your pain improves and as advised by your healthcare team.

Q9. What is the best way to sleep comfortably after surgery?

Sleeping can be challenging during the first few weeks. The most comfortable position is usually sleeping on your back or on your uninjured side, semi-upright in a recliner chair or propped up with several pillows in bed. Placing a pillow under your surgical arm and hand helps keep your elbow elevated, which reduces swelling, throbbing, and accidental movement during the night.

Q10. When can I start moving my elbow and beginning physical therapy?

Early motion is crucial for preventing elbow stiffness. In most cases, if the bone fragments are securely fixed with the plates and screws, you will be encouraged to start gentle range-of-motion exercises within the first 1 to 2 weeks after surgery. Formal physical therapy is typically started around this time to guide you through safe exercises to regain rotation, flexion, and extension of the elbow.

Q11. What are the common risks or complications of this surgery?

As with any surgery, there are potential risks, which include:

• Elbow stiffness or loss of full range of motion.
• Infection at the surgical incision site.
• Nerve irritation, particularly to the nerves that pass close to the elbow, causing temporary numbness or weakness.
• Nonunion (the bone failing to heal) or hardware irritation.
• Heterotopic ossification (abnormal bone growth in the soft tissues around the joint).

Q12. How long does it take to fully recover and return to daily activities?

Recovery is a gradual process. The bone typically takes about 6 to 8 weeks to heal, during which you will have lifting restrictions. Most patients can return to light daily activities (like writing or typing) within a few weeks, but returning to heavy lifting, sports, or manual labor usually takes 3 to 6 months. Achieving maximum strength and range of motion can take up to a full year of rehabilitation.

Q13. Will I need to have the plate and screws removed in the future?

In most cases, the micro-fragment screws and low-profile plates are designed to stay in your elbow permanently. However, if the hardware becomes irritating, rubs against tendons, or causes discomfort due to the lack of soft tissue over the elbow, it can be removed in a minor outpatient procedure once the bone is completely healed (usually at least 6 to 12 months after the initial surgery).

Q14. When should I contact Dr. Veillette's team or seek immediate care?

You should contact the clinic immediately if you experience any of the following warning signs:

• A sudden increase in pain that is not relieved by your medications.
• Increased redness, swelling, warmth, or drainage around the incision.
• A high fever (above 38°C or 100.4°F) or chills.
• Numbness, tingling, or weakness in your hand or fingers that is new or worsening.
• The splint or dressing becomes excessively tight, wet, or damaged.

Q15. What can I do to achieve the best possible recovery outcome?

To ensure the best recovery:

• Strictly follow all weight-bearing and lifting restrictions.
• Attend all scheduled physical therapy sessions and consistently perform your home exercises.
• Keep your incision clean and dry until your sutures are removed.
• Eat a healthy, balanced diet rich in calcium and vitamin D to support bone healing.
• Avoid smoking or using nicotine products, as they significantly delay bone and tissue healing.

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.