Surgical fixation with plates and screws (most cases) or total elbow replacement (selected elderly patients)
Content reviewed by✓Mr Andrew Davies, PhD FRCS (Tr & Orth)· Reviewed June 2026A broken elbow near the joint usually needs surgery. The most important thing to know is that physiotherapy must begin within days of the operation, starting early is critical to avoiding permanent stiffness.
Step 1, The most important thing: early movement
ℹ️ The elbow joint stiffens very quickly after injury and surgery. Physiotherapy must begin within 48–72 hours of your operation. This is the single most important factor in a good outcome. The exercises will be uncomfortable at first, but starting early, even when it hurts, is essential.
Surgery involves fixing the fracture with one or two metal plates and screws along the bones of the elbow. This is performed under general anaesthetic and takes 2–4 hours depending on complexity. Some patients stay in hospital for 1–2 nights.
Physiotherapy within 48–72 hours, non-negotiable
The elbow stiffens rapidly. Your physiotherapy appointment should already be booked before you leave hospital. If it is not, contact the team urgently. Starting late significantly worsens the outcome.
Active elbow movement begins immediately
Gentle active bending and straightening of the elbow begins within days. You will be given a specific exercise programme. Do these several times a day.
Keep the arm elevated
Elevation reduces swelling, which helps movement. Rest with the arm raised on pillows at the level of the heart, particularly in the first 2 weeks.
Do not force the elbow
Do not use your other hand to force the elbow into a position it cannot reach comfortably. This causes scar tissue formation and worsens stiffness. Active movement only, the elbow moves itself.
The day of surgery
ℹ️ You will be given a specific arrival time. Have no food from 2am on the day of surgery; you may drink clear water until 6am. Bring your medication list and any documents sent by the hospital.
Arrive at the time given
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Consent and marking
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
Anaesthetic
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
Recovery room
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
In hospital
Most patients having arthroscopic or day-case procedures go home on the day of surgery. Those having joint replacement typically stay 1–2 nights. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
Pain control
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
Wound check and dressing
A nurse will check the wound before you leave and explain how to keep it clean and dry.
Discharge letter and follow-up
You will receive a letter for your GP and details of your next outpatient appointment - usually at 2 weeks for a wound check.
You must not drive yourself home
Arrange for a family member or friend to collect you. You must not drive on the day of surgery if you have had a general anaesthetic or sedation.
Going home
⚠️ Important: Contact your team promptly if you notice increasing warmth, redness, or discharge from the wound, or if movement is not improving at all despite regular exercises.
Keep the wound clean and dry
Avoid getting the wound wet until it is fully healed - usually 10–14 days. Use a waterproof cover or cling film when showering.
Take your pain relief as prescribed
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective.
Attend your wound check appointment
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
When to contact the hospital
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, or a temperature above 38°C - these may indicate infection.
Recovery week by week
Surgery and first physio
Operation performed. Physiotherapy begins within 48–72 hours. Active elbow exercises start.
Daily exercises
Active elbow bending and straightening exercises throughout the day. Wound healing. Elevation to reduce swelling.
Strengthening begins
Progressive strengthening. Range of motion continues to improve. Return to driving when elbow has adequate movement.
Continued improvement
Most improvement happens in the first 6 months. Some stiffness is normal and expected.
Final result
Most patients achieve a functional arc of movement (about 30–130° of bending). Full extension is rarely regained.
Will I get full movement back?
Probably not completely, some degree of stiffness is almost universal after complex elbow fractures. However, if physiotherapy begins promptly and you exercise consistently, most patients achieve a functional range of movement sufficient for daily activities. Starting physio early is the single most important factor.
When can I drive?
When the elbow has enough movement and strength to control the vehicle safely, usually around 8–12 weeks. Your surgeon or physiotherapist will advise you when this is safe.
What is a total elbow replacement and why might I need one?
In some elderly patients where the fracture is too badly broken to fix, the joint surfaces are replaced with metal components instead. This gives more predictable results in this group. It comes with a permanent weight restriction of 1kg with the operated arm for life.
Recovery calendar
A week-by-week guide to recovery. Individual timelines vary, always follow your surgical team.
Consent information
Purpose and intended benefits
For ORIF: the aim is to restore the articular surface of the elbow and achieve stable fixation of both columns, allowing immediate post-operative physiotherapy and preventing elbow stiffness. For elbow replacement: reliable pain relief and functional elbow movement without the need for fracture healing.
What the procedure involves
ORIF: under general anaesthetic, through a posterior elbow incision, the fracture is exposed. The articular surface is reconstructed and the two columns are fixed with plates (one on each column - parallel dual-plate construct). The ulnar nerve is identified and protected or transposed. Immediate post-operative physiotherapy begins within 48-72 hours. Takes approximately 2-3 hours. Total elbow replacement: the fracture fragments are removed and a total elbow prosthesis is inserted. Permanent 1kg weight restriction applies.
Alternative treatments
Non-operative management
Only appropriate for undisplaced stable fractures with intact active extension. Very rarely applicable for displaced distal humeral fractures.
ORIF
The standard treatment for most displaced distal humeral fractures. Aims to restore the elbow and allow healing.
Total elbow replacement
For elderly patients with fractures not amenable to reliable fixation due to osteoporosis or comminution. Carries the permanent 1kg weight restriction.
Risks of the procedure
The most common long-term complication. Despite early physiotherapy, permanent loss of full extension is common. A functional arc of motion (30-130 degrees) is the realistic goal in complex fractures.
Pre-existing or new ulnar nerve symptoms after surgery, causing numbness and tingling in the ring and little fingers. Usually improves but may be permanent.
Failure of the fracture to heal, requiring further surgery.
Wound or deep infection. May require further surgery and implant removal.
Abnormal bone formation around the elbow joint, which may further limit movement.
Plates may cause skin prominence or irritation and require removal after confirmed fracture healing.
Degenerative arthritis developing in the reconstructed joint years after injury.
Expected and managed with regular analgesia.
Extensive bruising and swelling around the elbow are normal after distal humeral fracture surgery.
From ulnar nerve handling during surgery. Usually resolves.
If you choose not to have surgery
For displaced distal humeral fractures, non-operative management generally gives poor results, with a high chance of the fracture failing to unite and leaving a painful, stiff elbow with very limited function. For this reason, surgery is usually recommended for displaced fractures to give the best prospect of a useful, functioning elbow. Undisplaced, stable fractures may be suitable for non-operative management.
Your questions, answered
Plain-English answers to the things people most often ask, drawn from real patient questions and grounded in published guidance. Tap a question to open it.
About thisWhat is a distal humerus fracture?
It is a break at the lower end of the upper-arm bone, right at the elbow. It often involves the joint surface and usually follows a fall. Because it is close to the elbow, stiffness afterwards is a particular concern.
Your choiceDo I need surgery?
Many of these breaks, especially when displaced or involving the joint, are fixed with plates and screws so the elbow can start moving early. Some stable breaks are managed without surgery. Your surgeon decides based on the fracture pattern and your needs.
Getting backWhat is recovery like?
Early, guided movement is important to avoid a stiff elbow. The bone heals over several weeks, but regaining a full bend and straightening can take several months of physiotherapy, and some loss of movement can remain.
StiffnessWhy is stiffness so common?
The elbow stiffens easily after injury and surgery. Sticking closely to your physiotherapy programme is the single most important thing you can do to regain movement.
Pain & medsHow do I manage pain and swelling?
Pain relief, keeping the arm elevated to settle swelling, and starting the gentle movements you are given all help in the early period.
UrgentWhen should I seek urgent help?
Numbness, tingling or weakness in the hand, a cold or pale hand, severe or increasing pain with tight swelling, or a wound becoming hot, red or discharging, all need prompt review.
PreparingHow do I prepare for surgery?
You will have a pre-assessment and anaesthetic review, and advice on any medicines. Arrange help at home, as you will likely begin guided movement soon after the operation.
WellbeingI am worried about ending up with a stiff elbow.
That is understandable. Early physiotherapy and a realistic timeline give the best chance of good movement. Raise any concerns about progress early so they can be addressed.
- NHS: Broken arm or wrist
- Versus Arthritis: elbow pain
- British Elbow & Shoulder Society: exercises for elbow stiffness
- British Elbow & Shoulder Society: patient information
These links are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.