Elbow Fracture: Diagnosis and Treatment
The discussion of elbow fracture on this page will be limited to fractures of the lower end of the humerus bone in adults. Other fractures that involve bones forming the elbow joint can be
seen by clicking on the following links-
Radial Head Fracture
Before we go further with elbow fracture, it is important to know the about the lower end of the humerus bone. This part of the humerus is flattened out like a spatula and consists of
the following structures
- the lateral condyle outer side
- the medial condyle on the inner side
The medial condyle has the trochlea that articulates with the ulna bone and the lateral condyle has the capitulum that articulated with the radius bone. As you can see in the photograph that the
posterior or under surface of the humerus bone is relatively flat hence this is the place that is used to apply plates and screws for stabilization of these fractures.
Also see the page on elbow anatomy for a better understanding of these fractures.
In young people these fractures are caused by high energy injuries such as road traffic accidents whereas in elderly they are seen after low energy injuries such as slipping
on the floor.
Symptoms of elbow fracture include the following
- pain around the elbow region
- inability to move the elbow joint
- deformity around the elbow
Movements of the wrist and fingers will continue until there is some injury to the blood vessels and nerves. In my country I have seen many patients come late after a elbow or
shoulder fracture thinking that since they can move their fingers so they do not have a fracture and their injury is only a sprain.
Diagnosis of elbow fracture is by x ray examination of the elbow joint. A CT scan may also be required to assess the fracture pattern in multi fragmentary fractures.
These fracture can be broadly classified into three types
- Extra-articular fractures in which the fracture line does not extend to the elbow joint
- Partial-articular fractures in which the fracture line extends to the elbow joint and one condyle remains attached to the humerus bone
- Complete-articular fractures in which the fracture line extends to the elbow joint and both the condyles are separated from the remaining humerus bone
Each of the above types can be of further two types
- Undisplaced or hair line in which the fracture fragments have not separated from each other
- Displaced in which the fragments are away from each other
Treatment of this fracture depends on the following factors
- classification of the fracture
- age of the patient
functional requirements of the patient
active life style
sedentary and dependent life
presence of other diseases such as stroke, heart failure, diabetes etc.
Undisplaced or hair line fractures can be treated by simple plaster or splint support for 3 to 4 weeks after which physiotherapy is started to bring back
movement in the elbow joint as soon as possible.
Displaced fractures in active young adults are treated by surgery. During surgery the fracture is exposed through a incision and the fragments are aligned. These fragments are then held
rigidly by the help of plates and screws. The plate screw construct should be so strong and stable so as to allow active movement in the post operative period.
This approach is also used in old people that are fit for surgery.
A elbow fracture in sedentary and dependent elderly people or those that have diseases like stroke, heart failure that make them surgically unfit are treated by
- a short period of rest in a splint or sling for a few days
- pain killers and anti-inflammatory drugs to reduce pain and swelling
- physiotherapy is started within a few days to maintain mobility with out worrying about fracture union
The aim of this treatment is to get back as much painless movement of the elbow joint as possible.
Elderly patients with arthritis of the elbow joint or with multi-fragmentary fractures that can not be adequately stabilized by plates and screws are taken up for
total elbow replacement surgery.
This is a x ray of a patient treated for elbow fracture with plates and screws.
- Non-union or inability of the fracture to heal
- Mal-union or healing of the fracture in a wrong position
- Loss of elbow movement
- Nerve injury
- Irritation caused by plates, screws and wires placed under the skin
Frequently Asked Questions
How long does the fracture take to heal?
This fracture usually heals in 6 to 8 weeks.
How can loss of elbow movement be prevented?
Loss of elbow movement can be prevented by early and active physiotherapy after rigid stabilization of the elbow fracture.
Elbow Fracture Case Study
These x rays above are of a young male who sustained a elbow fracture in a road traffic accident.
He was treated by fixing both the medial and lateral condyles with plates and screws. The reconstruct was strong enough for him to start movement of the elbow joint immediately after surgery.
Below are his postoperative x rays.
These photographs below show his range of motion 1 month after surgery.
These photographs below show the range of movement 4 months after surgery. Now he has nearly full range of movement at the elbow joint.
This is the x ray after complete fracture healing.
I hope the above information was useful. If you have any query you can ask me at the contact me page.
This page was updated on 24th September 2015
Other fractures and dislocations of the elbow region in adults...
Radial Head Fracture
Other fractures of the elbow region in children...
Lateral Condyle Fracture
Other causes of elbow pain...
Little League Elbow
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