The elbow joint is a hinge joint that forms the junction of three bones: the humerus (upper arm bone), the radius and ulna (forearm bones). The bones are held in place by ligaments, tendons and muscles.
A fracture is a term used to describe a break in a bone. A fracture can range from a hairline crack through to complete displacement of the bones. A fracture can also be comminuted meaning it has multiple pieces to it.
Elbow fractures can result from a fracture in any of the three bones at the elbow junction
Distal humerus fractures
- The distal humerus refers to the lower end of the upper arm bone. It meets with the radius and ulna to form the elbow joint. The distal humerus creates the top of the elbow joint. This one joint allows for two movements to occur with the tow bones of the forearm. Where the humerus and the ulna meet, flexion and extension occurs. Where the humerus and radius meet twisting or rotation occurs.
Radial head and neck fractures
- The radial head and neck is the upper part of the radius, it is one of the bones of the forearm. The radial head is an important part of the elbow joint that allows twisting of the forearm. Fractures that occur at the radial head or neck are completely within the elbow joint.
- The olecranon is the bony point of the elbow that is easily felt. The olecranon is the upper part of the forearm bone, the ulna. Fractures can be a crack in the olecranon or the tip of the olecranon can completely break away.
Fractures to any of the bones in the elbow can result from:
- Falling directly onto the elbow
- Falling onto an outstretched arm
- Sporting accident
- A direct blow
- Motor vehicle accident
Fractures to any of the bones in the elbow joint will cause immediate pain. Other symptoms include:
- Swelling of the elbow
- Bruising around the elbow
- Pain on movement of the elbow that may prevent movement
- Pain on rotation of the forearm
- Restriction of movement of the elbow (flexion/extension/rotation)
- Localised tenderness
- Numbness in one or more fingers
If you are experiencing any of the symptoms above following an injury to your elbow, you should see your doctor or present to the emergency department.
Your doctor will ask you questions about the nature of your injury and your symptoms. An examination of the shoulder, arm, elbow, forearm and hand will also be performed.
An Xray is usually performed to confirm a fracture to any of the bones around the elbow.
A CT (computed tomography) scan may be required if an x-ray does not show the fracture lines clearly or the fracture involves elbow joint surfaces.
A MRI (magnetic resonance imaging) scan may also be done to identify injuries to other structures such as ligaments.
Immediately following the injury, applying ice to the affected elbow and pain relief medication may provide comfort whilst waiting for treatment.
The the fracture is well aligned you may be able to treated with imbolisation of the elbow joint. This can involve a sling, brace or cast. Your exact fracture pattern to help to determine which is best and for how long the treatment needs to continue.
Surgery is commonly needed for fractures that occur around the elbow. Surgery may be required if the bones are not aligned, if there is a break involving the joint surface or if there is instability of the elbow joint. Surgery may also be required where there are several fragments of bone.
Plates and screws are often used to fix fractures around the elbow. Sometimes wires placed through small cuts the skin, and supported by a cast, may be used to hold fractures in place.
Occasionally, when there are severe fractures that affect the elbow, it is necessary to place a frame around the elbow to support it. This can be used for very comminuted fractures (many pieces) or for fractures that have an associated dislocation of the elbow joint.
If parts of the elbow joint are not able to be put back together, parts or all of the elbow joint can be replaced. Radial head fractures can be treated with a small joint replacement if the joint surface is too badly damaged to be reconstructed.
The elbow is very likely to get stiff after an injury, and prolonged physiotherapy is sometimes necessary to overcome this.
- Infection and wound breakdown
- Damage to the blood vessels and/or nerves
- Swelling and stiffness in the elbow
- Prominence of metal work, removal of metal work
- Failure of fixation – sometimes the bones are not strong enough to be held together with plates, screws or wires. This will often require further surgery.
- Nonunion – non-healing of the bone. Factors increasing the risk of nonunion include: