Shoulder and elbow fractures can be complex. We recently sat down with Ian Byram, M.D., a subspecialist at Bone and Joint Institute of Tennessee, to learn more about his experience in treating these injuries, as well as training other specialists within his field.
Dr. Byram frequently instructs other surgeons at the regional and national level in performing these procedures. This September in Nashville, he’s hosting a national site for shoulder and elbow awareness week for the American Shoulder and Elbow Society (ASES). As a frequent contributor to the specialty, he collaborates with ASES and the Association of Clinical Elbow and Shoulder Surgeons (ACESS) to share difficult cases and innovate the field.
WS: Let’s start with the basics. Are fractures and breaks the same thing?
Fracture and break are synonyms. People ask if they broke a bone or fractured it, but those are the same terms. Just because you fractured a bone does not mean you need surgery. We take a lot of factors into consideration: age, activity level, type of fracture, location of the injury, and we combine all that data to make the best decision about how to help a patient regain function while minimizing the need for surgery.
WS: Who is a good candidate for shoulder surgery?
When the fracture involves the cartilage-bearing surface of the ball or socket in the shoulder or the elbow is unstable, that can lead to rapid onset of arthritis and poor function. We either try to realign the joint and restore native anatomy or – if damaged beyond that point – we will consider replacing the joint. In the shoulder, that often means replacing both sides of the joint. In the elbow, in particular, that can mean replacing one part of the joint – for example a radial end replacement (a “partial replacement”).
WS: How successful is shoulder replacement surgery overall?
It’s a really successful procedure, especially in the older patient who puts lower demand on their shoulder. It can be done in younger patients, as well, but the younger the patient is, the more likely we are to try to retain their native anatomy. I have replaced the shoulder in patients after fracture and they have returned to high-level function, including golf, horseback riding, and tennis.
WS: Have there been any recent technological advancements in fracture repair that have changed the quality of care patients receive?
Typically when we surgically fix fractures in bones we use plates and screws to stabilize the bone. The technology of plating fractures has improved as plates are now more customized to fit the patient’s anatomy. They are made of lighter weight material like titanium instead of bulky stainless steel. There’s a technology called locking screw technology that allows us to obtain good fixation in poor quality bone.
These fractures can occur anywhere and in anyone: from children jumping on a trampoline to grandmothers falling while standing. Older generation plates used to be more prominent on the bone – especially on the collarbone where there’s just not a lot of muscle. A bulky plate can be annoying or uncomfortable, whereas a lower profile lightweight titanium plate tends to fit and sit more comfortably and is less noticed by the patient.
We do use CT scans to better understand fractures, especially around the joint in the ball of the shoulder, socket of the shoulder, or around the elbow. We can now use those CT scans in planning either fixation or replacement of the joint. That’s been one of the bigger advances in shoulder surgery: using CT scans for planning and intraoperative guidance when placing the implant.
Similarly in the elbow, there have been technological advancements for replacement – even arthroscopic techniques that aid in the fixation of fractures or dislocations.
WS: How does the collaborative approach of Bone and Joint Institute help patients receive the best care?
From the moment you have an injury, whether you’re seen at Williamson Medical Center ER or any other emergency medicine facility, we can take over your care. We’re highly accessible because of our After-Hours and urgent care clinics, located in our primary office in Franklin, as well as Nolensville and Thompson’s Station.
These clinics will allow you to be referred to a specialist who can treat your particular injury. If it requires surgery, that’s something we can plan and do in our own facility. During the recovery stages – or if the injury is treated non-surgically – we work with our therapists to help you regain function as early as possible. Our Occupational Therapists are able to create custom splints that help protect the elbow in particular and our bracing experts fit the patients for certain types of braces as well.
WS: What do you enjoy most about your work?
First and foremost, I enjoy taking care of patients in our community and helping them get back to the activities that they love and enjoy. It’s really satisfying to see someone recover from a bad injury. But I also enjoy working in a field with constant advancements that allows me to be on the cutting-edge of technology. In particular, I have an interest in clinical research and product development. The desire to constantly be improving technology is something that drives me to provide for our patients.
Shoulder and Elbow Fractures at Bone and Joint Institute of Tennessee
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