Some shoulder or elbow fractures require surgery in order to ensure that the bone heals fully. NYU Langone orthopedic surgeons have the expertise to determine when surgery is the best option to restore joint function and which surgical technique is most appropriate.
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An open fracture, in which a bone breaks through the skin, usually requires surgery to reposition the bone, fix bone fragments into place, and close the wound. Doctors also recommend surgery for displaced fractures, in which the pieces of a broken bone separate from each other but remain beneath the skin.
A doctor may also recommend surgery if a fracture limits joint function—for example, if a fracture in the elbow prevents the joint from extending fully—or if a bone fracture results in damage to soft tissues such as tendons, ligaments, nerves, or blood vessels.
An injury sustained in a car accident or high-impact trauma may require more than one surgical procedure to repair damage to soft tissues and put the bone fragments back into place.
When serious injuries such as open fractures occur, immediate surgery may be required at NYU Langone.
For less severe fractures, or if the injury causes significant swelling or bleeding, surgery may be scheduled later to allow bleeding and swelling to lessen. Your doctor may provide you with a sling to immobilize the arm during this time and may also prescribe pain medication for a few days to help keep you comfortable.
Your surgeon decides on the most appropriate surgical procedure for your shoulder or elbow based on extent of the injury, what type of accident occurred, how much of the joint was affected, and whether any blood vessels, nerves, tendons, or ligaments were damaged.
Regardless of the specific surgical approach, the goals of surgery are to restore the broken bone to its original position and apply a device to hold the bone fragments in place while they heal. Doctors call this two-step process reduction and fixation.
Reduction and fixation are crucial to ensuring that the bone heals. If a broken bone is not put back together, or if the bone is not stabilized during healing, the bone may not be able to regrow new tissue. This condition is called a nonhealing fracture and may persist for months or years if left untreated.
NYU Langone surgeons perform open reduction and internal fixation using regional or general anesthesia. This procedure is used to set a broken shoulder or elbow bone and stabilize the bone fragments so they can heal.
In the shoulder, a surgeon may perform this technique to repair a broken clavicle or proximal humerus.
In the elbow, open reduction and fixation may be performed for a fractured distal humerus, the upper arm bone, or olecranon, the bony tip of the elbow. Fractures of the radial head or scapula usually don’t require surgery, but if a fracture interferes with joint function or breaks the skin, doctors may need to operate.
In an open reduction, a surgeon makes an incision over the fractured bone to see the pieces of a broken bone and assess how well they can be put back together. If any bone fragments are too small to be put back into position, the surgeon may remove them.
After the bones are in the correct position, a surgeon fixes them into place using stainless steel wires, plates, or screws. These parts stay in the body permanently and keep the bones in place while they heal and grow back together. In repairing a fractured olecranon, the surgeon may also use thin, strong pieces of wire to hold the bone fragments in place.
If necessary, the surgeon also repairs injured soft tissues during surgery. After the surgeon has completed the procedure, he or she closes the incision with stitches or staples.
Your surgeon may use a bone graft, which is a small piece of living bone tissue, to replace any pieces of bone that were lost as a result of the injury. A bone graft may be obtained from a person’s own body—typically the hip—or from a donor through a bone bank.
When implanted into a fractured bone, the graft acts as scaffolding on which new, healthy bone cells grow. Over time, the graft fuses with the original bone, forming one solid bone.
Internal fixation may not be the most effective treatment option if an injury causes the elbow to dislocate—meaning the bones of the elbow joint separate from each other—in addition to an elbow fracture. This type of injury can make setting the bone more difficult.
A surgeon may use an external fixation device, which is worn outside the body, to keep the bone fragments from moving and to prevent the elbow from dislocating again. The device is a hinged metal frame that surrounds the injured elbow. It stabilizes the fracture using wires or pins that are inserted through the skin and into the affected bone.
After a period of healing, your surgeon removes the device.
If a shoulder or elbow fracture is severe or if the bone quality is so poor that it will not hold fixation devices—such as in people with osteoporosis—surgical repair using reduction and fixation is unlikely to be successful. Instead, your surgeon may perform partial or total joint replacement. In this procedure, the damaged parts of the joint are removed and replaced with durable prosthetic parts.
An artificial shoulder joint consists of a metal ball attached to a metal stem, which mimics the rounded top of the arm bone, and a plastic socket that is fitted into the shoulder blade. These parts are shaped to fit perfectly in your shoulder joint space and, when combined, result in a smooth and painless gliding motion.
In the elbow, surgeons implant a device made of plastic and metal that acts like a hinge. Attached to each side of the hinge is a metal stem. Above the elbow, the stem is fitted into the humerus; below the elbow, it is fitted into the ulna. A prosthetic elbow restores range of motion and provides long-lasting stability in the joint.
After surgery, a pain management specialist ensures that you have the medication you need to remain comfortable while the fracture heals. The length of your hospital stay depends on the extent of the injury and the type of surgery performed. Some people go home the same day, and others stay overnight for observation.
Before you leave the hospital, your doctor may apply a plaster cast over the arm and elbow or provide you with a sling or splint. These devices immobilize the affected shoulder or elbow while the bones heal.
Your surgeon determines the length of time you wear a cast or sling based on several factors, including the location and extent of the fracture, the type of surgery performed, and whether there is soft tissue or vascular damage as well as a fracture. Your age is also a consideration. In general, younger people heal more quickly than older people because their bones regenerate faster.
Your surgeon sees you for a follow-up appointment about one week after surgery to make sure the bone is healing well. At that time, your doctor determines when you should begin physical therapy.
At first, a physical therapist shows you how to do simple exercises to maintain range of motion in the adjacent joints unaffected by the injury. For example, if you have a fractured collarbone, doctors encourage early range of motion exercises in the elbow and wrist of that arm. Physical therapy appointments usually continue twice a week as you build strength.
During the following weeks, your surgeon may schedule periodic visits to monitor how the bone heals. He or she may use X-rays to ensure that the bone fragments remain in place and confirm that the bone is healing actively. As pain lessens and you are able to move the affected arm, your physical therapist helps you restore range of motion, improve flexibility, and build muscle strength.
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