Fractured Elbow

Elbow fractures are commonly encountered in the acute care setting. Injury patterns for children and adults are quite different. 

Three bones make up the elbow joint: 

  1. humerus
  2. radius
  3. ulna
Diagram of the elbow labelling the humerus, radius and ulna and the cartilage lining the joint

Also when you bend your elbow, you can easily feel the tip of the bone of the elbow. The bone is called the olecranon.

These bones are held together by ligaments. The muscles are attached to the bones by tendons. With little protection, any of these bones can be involved in a fracture. Along with the fracture the ligaments and tendons may be torn.

Diagram of a Monteggia injury: the ulna fractured just below the elbow with the radius dislocated from its joint with the humerus

Symptoms

Patients with an elbow fracture may complain of severe pain and limited elbow movement. 

1. Painful on elbow movements 

2. Swelling & bruising at elbow joints

3. Tenderness around the elbow

4. unable to straighten the arm

5. Numbness in fingers

Causes

Fracture of the elbow can be caused by direct trauma:

– Car/bike accident

– Fall down or by landing on an outstretched hand

– Struck by hard objects (e.g. baseball bat)

Risk Factors

Most fractures at the elbow joint occur in children. 

Four views of a supracondylar elbow fracture, showing the break through the humerus just above the joint

Investigations

The patient will be examined first by the doctor. This will establish the location and extent of the fracture. 

The orthopaedic doctors will then request X-rays of the upper arm, forearm, shoulder, wrist and/or hand, based on the examinations and patient’s complaints. 

X-ray findings may reveal altered alignment of the joints, a change in the size of the joint space, and a line on the bone (representing the fracture line). A CT scan or an MRI may be needed if the fracture cannot be seen on the plain X-ray despite the symptoms.

Complications

  1. Nerves and the blood vessels that run in the elbow joint can be injured in an elbow fracture, which can cause serious problems.
  2. The wound could be infected and may allow infection to spread into the bone.
  3. The bones may also fail to unite properly which may result in some weakness or deformity of the arm.
Diagram of the inner arm showing the ulnar nerve passing the elbow alongside the biceps muscles

Treatment

In the emergency setting, the doctors will try to reduce the complications of the fracture with ice, pain medicine, a splint (like a cast), and a sling to keep the elbow in position.

Bear in mind that not all elbow fractures need a surgery. The doctors need to do some investigations before deciding whether to operate on a patient’s elbow. 

Conservative

Some elbow fractures require only a splint or sling to hold the elbow during healing. However, the patient needs to come back a few times to the hospital to have X-rays.

If the bones are showing good signs of healing (no bony fragments are out of place), the doctors will allow the patient to begin gently moving the elbow and visit the physiotherapist.

Surgery

The surgery is generally safe. There are two conditions for surgical treatment:

  • The fractured bone is out of place. The olecranon is important in straightening the elbow, as a muscle attaches to it.
  • The fracture is associated with a big skin cut or “open fracture”. As the risk of infection is higher in such fracture, the patient will need a course of intravenous antibiotics and may require a tetanus shot. In the theatre, the wound needs to be checked and washed out, while the bone will typically be fixed during the same time. 

For this surgery, the patient is put to sleep and may lie on the back, side or stomach. If the patient lies on the belly, the face may be swollen for a few hours after the operation. However, this is normal and temporary. 

The doctors may use pins/wires, screws, plate and screws, or stitches to put the pieces of the bone back together. 

Seeking Advice

Your Family Doctor (GP)

Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to

  • tell you about your problem
  • advise you of the best treatment methods
  • prescribe you medications
  • and if necessary, refer you to Specialists (Consultants) for further treatment

Prevention

Unfortunately there isn’t much to do to prevent elbow fractures!

F.A.Q. | Frequently Asked Questions

  • When may I start using my arm to lift objects?
    • You are not allowed to lift anything with the injured arm for 2–3 weeks. 
  • When may I start moving my elbow?
    • The doctor will advise when you can move it, based on the follow-up X-ray.
  • Are there any factors that might make my healing take longer?
    • Smoking, diabetes or other health problems may affect the healing process. 
    • If the fracture was associated with a large cut in the skin
  • What are the risks of surgery?
    • Infection
    • Pain
    • Damage to the nerves and blood vessels
      • These are all very rare in the hands of an experienced orthopaedic surgeon. 
  • What can I expect for the near and far future?
    • The elbow function should return 100% unless complicated by other health problems.