This is a randomized double blind placebo controlled study to investigate the hypothesis that injection of botulinum toxin A into the muscles surrounding the elbow following the surgical treatment of an elbow fracture will reduce postoperative stiffness and improve function.

This is a randomized double blind placebo controlled prospective study in which botulinum toxin A (Botox®) or normal saline will be intraoperatively injected into the muscles surrounding the elbow following the surgical treatment of an elbow fracture or elbow fracture dislocation.

Eligible patients will be identified by the Principal Investigator in his practice or by fellows and residents from the clinic population and emergency department admissions. After providing informed consent, all subjects will undergo a baseline examination that will include a medical and orthopaedic history, physical examination, and radiographs. The surgical procedure itself will not differ from the standard care for elbow fractures. The only difference is injection of Botox® or normal saline into the muscles of the injured arm. Subjects will undergo post-operative evaluation at various intervals for up to two years. The study and control group will be compared to each other and to contralateral arms in regards to elbow range of motion, patient questionnaire scores (DASH) and an observer-based elbow scoring system (Broberg and Morrey).

Traumatic injury to the elbow resulting in a fracture or fracture/dislocation of the elbow often leads to a stiff elbow with limited function. Posttraumatic elbow stiffness is a common problem that is difficult to manage. The best way to decrease the morbidity is through prevention. An intraoperative injection of Botox® has been effective in treating upper limb spasticity disorders and may prevent the development of elbow stiffness, and decrease the need for future surgery to regain motion.

Inclusion Criteria:

• Capable of providing informed consent
• 18 years old and older
• Elbow fractures that require operative intervention including:
• Supracondylar distal humerus fractures
• Intra-articular distal humerus fractures
• Proximal ulna and radius fractures

Exclusion Criteria:

• Patients less than 18 years old
• Injuries that do not normally require surgical repair
• Patients with underlying spasticity
• Patients with burns about the elbow
• Patients with extensive soft tissue injuries of the elbow
• Patients with head or spinal cord injuries
• Myasthenia gravis, Eaton-Lambert, amyotrophic lateral sclerosis or any other disease that interferes with neuromuscular function
• Use of aminoglycoside antibiotics or other drug therapies that interfere with neuromuscular function

• Limited statistical power: Limitations in time and funding as well as difficulties in recruiting
• Blinding challenges: Weakness in the flexor muscles of patients receiving botulinum toxin injections was clinically apparent