Fractures of the Elbow

When you bend your elbow, you can easily feel its tip, a bony prominence called the olecranon that extends from one of the lower arm bones (the ulna). It is positioned directly under the skin of the elbow, without much protection from muscles or other soft tissues.

It can easily break if you experience a direct blow to the elbow or fall on a bent elbow. Elbow fractures may result from falling onto an outstretched arm, a direct impact to the elbow, or a twisting injury. Sprains, strains, or dislocations may also occur at the same time as a fracture.

Symptoms

A snap or pop at the time of injury may be felt or heard. Symptoms of an elbow fracture include:

• Sudden, intense pain
• Inability to straighten elbow
• Swelling over the bone site
• Bruising around the elbow
• Tenderness to the touch
• Numbness in one or more fingers
• Pain with movement of the joint

Causes

There are many types of elbow fractures (breaks):

• Radial head and neck fractures
• Olecranon fracture
• Fractures of the distal humerus
• Displaced supracondylar humerous fracture

Olcranon fractures are common, although they usually occur in isolation, they can be a part of a more complex elbow injury. Olecranon fractures can occur in a number of ways:

• A direct blow. This can happen in a fall (landing directly on the elbow) or by being struck by a hard object.

• An indirect fracture. This can happen by landing on an outstretched arm. The person lands on the wrist with the elbow locked out straight. The triceps muscle on the back of the upper arm help "pull" the olecranon off of the ulna.

Treatment Options

Stiffness is a major concern after any elbow fracture, therefore treatment is focused on maximizing early motion. Some elbow fractures require just a splint or sling to hold the elbow in place during the healing process. Your Celebration Orthopaedics hand surgeon will closely monitor the healing of the fracture and will schedule regular visits for x-rays. If none of the bone fragments are misaligned after a few weeks, the doctor will allow the patient to begin gently moving the elbow. This may require visits with our occupational therapists.

An elbow fracture may require long periods of splinting or casting. Casts are used frequently in children, as their risk of developing stiffness is small; however, in an adult, elbow stiffness is much more likely. The elbow may become very stiff and require a longer period of therapy after the cast is removed to regain motion.

If the fracture shifts in position, the patient may require surgery to put the bones back together. Surgery to treat an elbow fracture is usually necessary when:

• The fracture is out of place, or displaced. Because the triceps muscles attach to the olecranon to help straighten the elbow, it is important for the pieces to be put together so you can straighten your elbow.
• The fracture is open and pieces of bone have cut the skin. Because the risk of infection is higher in an open fracture, the patient will receive antibiotics and may require a tetanus shot. The patient will promptly be taken to surgery so that the cuts can be thoroughly cleaned out. The bone will typically be fixed during the same surgery.

The surgeon will typically make an incision over the back of the elbow and then put the pieces of bone back together. There are several ways to hold the pieces of bone in place. Your Celebration Orthopaedics hand surgeon may choose to use:

• Pins/wires
• Screws only
• Plates and screws
• Sutures ("stitches") in the bone or tendons

Recovery

The ultimate goal of treatment for an elbow fracture is to regain full motion of the elbow. Therapy is often utilized to maximize motion. This might include exercises, scar massage, modalities (ultrasound, heat, ice, etc.), and splints that stretch the joint.

Most patients will return to normal activities (except sports and heavy labor) within about 4 months, although full healing can take more than a year.