Case Study - Turnbuckle Splint

May 2020

This 44yo gentleman, who lives about 5 hours drive away from Perth, fell 3.5m from a ladder 3 months ago. He landed directly on his elbow, resulting in a dislocation of the elbow joint and significant fractures to the proximal ulna and radius. He underwent reconstructive surgery (ORIF) to both bones, and his X-ray image below shows the extensive metalwork still in place.

Unsurprisingly, he has had difficulty getting his elbow moving again despite the best efforts of his local physios. His elbow is bending 125° - so he can just about get his hand to his face - but it is almost 70° away from being fully straight. This is resulting in great difficulty with any task that requires reaching or stretching.

Now that his surgeon is happy the bones are well healed, we can try a different strategy to gain some more elbow straightening. We fitted him with a custom-fitted elbow splint consisting of thermoplastic pieces above and below the elbow with a hinge joining them together. A metal turnbuckle was then added to the front of the splint. The patient can wind out the turnbuckle until he feels a very gentle stretch in his elbow, and can maintain this stretch for very long periods. Hopefully, the splint will be comfortable enough that he can even sleep in it!  Over time, the tight ligaments that are limiting his elbow motion should gradually be made longer in response to this sustained tension - a similar idea to using braces on crooked teeth to gradually straighten them.

It will be likely be at least 3-4 weeks before we know for sure if this approach is working for him.