Fracture elbow may result when there is a break in the bones forming the elbow joint. It may sometimes, be associated with injuries to soft tissues surrounding the elbow joint. Fracture elbow mostly occurs due to falls, direct blows or sports injuries and can take varying time to heal depending on the severity of the condition, associated injuries and the age of the person.
Understanding Fractured Elbow
Elbow joints are hinge joints of the hands that enable free movement of the elbow joint. It is formed with the long bone of the upper arm (humerus) and two bones placed side by side of the forearm (radius and ulna). Radius is placed at the thumb side of the hand while the ulna is located at the inner side or pinky side of the hand.
The elbow joint is formed with the union of these three bones and their particular parts, which actually form the hinge joint at the elbow. The distal or the lower part of the humerus is at the centre of the elbow joint. The head and neck of radius is connected to the distal humerus and rotates when the hand is twisted up and down. The olecranon is the bony point, which is felt under the skin at the elbow. It cups at the end of the elbow and rotates during the hinge movement.
Fractured elbow can be classified into the following types
Fracture in Bones of Forearm (radius)
Fractured elbow of this type affects the radius bone of the forearm. A break in this bone at the radial head and neck is very close to the elbow joint and affects the movement of the elbow joint. Pain in this type of elbow fracture worsens when twisting the hand to face the palm up and down.
Fractured elbow affects the pointed part of the elbow joint called olecranon process, which is felt beneath the skin at the elbow. This type of fractured elbow may cause severe pain and may be associated with dislocations.
Fracture in the Long Bone of Arm (Humerus)
This type of fractured elbow is common in children and aged persons. Due to the involvement of the bone in the arm, other delicate structures like arteries and nerves may be involved in the fracture elbow and should be carefully evaluated. Fractured elbow involving fracture of the long bone of the arm may require surgical correction in some cases.
Causes of Fractured Elbow
Fractured elbow can commonly occur due to falls and injuries to the hand. The commonest way is when a person falls on the hand or by directly landing on the elbow. Fractured elbow can occur when something hard hits the elbow, a direct blow to the elbow during sports or vehicular accidents. A direct blow can be experienced in sports injuries and can occur due to direct hit or fall on the ground.
Another way of elbow fracture occurrence is when a person falls on an outstretched hand with elbow straightened. The fall lands on the wrist, with locked elbow, which enables the triceps muscle located at the back of the arm, to pull the olecranon, resulting in a fractured elbow.
Symptoms of Fractured Elbow
The earliest signs and symptoms of fractured elbow include, severe pain following an injury, fall or similar event. Pain is often associated with stiffness, which is noted with an inability to move, bend or straighten the elbow. There is noticeable swelling and bruising around the elbow. Another sign of fracture elbow is a pop or crack may be felt or heard at the time of injury to the elbow, during a blow or fall.
The site of injury is tender to touch and may also have symptoms of bleeding if there is an injury to the skin surface. The swollen, tender area around the fractured elbow may also be hot to touch. Any visible deformity or change in shape of the elbow may indicate a sign of more severe fracture elbow or a dislocation.
As there are small vascular structures and nerves passing through this, a fracture elbow can cause injury to these structures. This can result in the patient experiencing signs and symptoms of numbness and tingling in the fingers. Sometimes, it can also cause weakness in the hands and arms. Such instances, which can be a severe form of fractured elbow may require immediate medical attention to avoid further damage.
Diagnosis of Fractured Elbow
Most cases of fractured elbow may turn up for emergency medical treatment. The main presenting features for almost all types of fractured elbow, including olecranon fractures are severe pain and swelling in the elbow. A diagnosis of fractured elbow can be made after thorough history, clinical examination and investigations.
History may reveal any falls, accidents, sports injuries or blows to the elbow that could have resulted in a possible fracture elbow. Clinical examination of the elbow includes examining the skin for cut wounds. Falls can cause cut wounds and abrasions on the skin area, while sometimes lacerations can be caused if the end of bones are broken. This needs immediate attention as it increases the risk of infection from open wounds.
Palpation of the injured elbow area can reveal tenderness in the region, particularly in case of fracture elbow or dislocation. Movement of the elbow, arms, hands and fingers is assessed to check for movement and sensation. Pulse checking at the wrist may be done to ensure proper blood flow to the hands and fingers.
In addition to this, investigations are done to confirm the diagnosis of fractured elbow.
X-rays of the elbow joint are taken to confirm fractured elbow, they also help to find injury to the bones, evaluate the extent of bone breaks, presence of any dislocation or any associated injuries. X-rays of other areas like hands, wrists and shoulders may also be taken depending on the history of injury to rule out any damage to these joints.
Other imaging studies and scans like CT scans or MRI of the affected area in fractured elbow may be ordered, if found appropriate. These may be done, when it is essential to check the functioning and rule out any injuries caused to the nerves, muscles and soft tissues around the elbow joint.
Treatment of Fractured Elbow
Like any other injury, fractured elbow needs to be attended at the earliest. Rest to the affected elbow is important. It can be tied with support as a part of the first aid treatment, depending on the severity. When done by medical professionals, a fractured elbow needs a splint or a cast is often placed and is supported with a sling. Applying ice packs to the swollen area, helps to reduce pain and swelling and the inflammation caused in the area of the elbow fracture.
Medications given to treat fractured elbow include anti-inflammatories and pain medicines. Other medicines may be given depending on the associated injuries or other medical problems. Most of the cases of fractured elbow, may settle down with non-surgical and medical management, however, some cases may require surgical correction for correct alignment of the bone.
Non-Surgical Treatment for Fractured Elbow
For most fractured elbow cases, a splint is placed to ensure immobilization of the elbow. It helps to keep the broken elbow in place to promote healing of the injury. This requires totally resting the elbow and not using it to bend or make any movements. Also, no weight should be lifted in the hand that has suffered a fractured elbow. This, in addition to pain medicines can take care of fractured elbow in most cases.
Casts and splints are placed in cases that have minor injuries, when the fracture elbow is not complicated or bones are not out of place and it needs immobilization for natural healing to take place. Children with fractured elbow are usually treated with casts and splints as they are active and that’s the only way to rest the elbow to promote healing. Moreover, the chances of causing elbow stiffness are less in case of children, which is a common concern when placing casts and splints, particularly in adults.
Recovery of Fractured Elbow
The treating physician monitors the condition frequently to check if the healing process of the fractured elbow is going fine. It may require few weeks for the bones in fractured elbow to set and heal. After the expected time, the physician finds that the fractured elbow has healed properly and to check if none of the bones are out of their position.
It may take 3 to 6 weeks in splint or cast, after which further action is taken. Depending on the healing and the improvement in the condition, cast may be removed and a bandage may be tied for support. Lifting weight is still not allowed in the affected hand with the fractured elbow. Slight movements may be permitted and the physician trains on the kinds of movements that can be done.
Depending on the severity of the elbow fracture and the rest period required, physical therapy is advised, to strengthen the muscles, tissues around the injured elbow and promote healing of fractured elbow. This continues for another few weeks or months depending on the severity of fractured elbow.
Physical Therapy for Fractured Elbow
Physical therapy plays an important role in healing of the fractured elbow and regaining the strength and function of the injured area. Sometimes, physical therapy may be initiated even when the fractured elbow is in splint. This may be done to prevent stiffness of the joints and to ensure normal blood flow in the region.
Physical therapy can help in training about movements of shoulders, wrists and fingers of the injured hand with fractured elbow. Simple exercises to maintain the functioning of these parts and the also the other unaffected hand of the body may be advised. Additionally, the therapist can help to train ways in which the injured hand can be managed while doing personal activities, handling objects, writing or typing and carrying out daily routine functions.
Physician usually guides about the progression for physical therapy and one needs to follow the advice for optimum results. Once the splint is removed, physical therapy can be properly aimed at the affected elbow and focused on its healing for fracture elbow. Other physical therapy treatment modalities for elbow fracture like ultrasound, electrical stimulation, cold packs, etc. may be used to reduce swelling and pain in the elbow.
Gentle exercises may begin for healing of fractured elbow, initially with passive exercises, where the therapist moves the elbow and supports the hand. Slowly this progresses to active exercises where active movements and stretches are encouraged. These can be done without help but is best done under supervision initially.
Physical therapy at this stage aims at improving flexibility and movement, reduce joint stiffness, increase muscle strength and endurance. Following the prescribed exercises can help to slowly improve these functions when recovering from fracture elbow. Gradually, it is possible to regain the required strength and resume normal activities.
For those involved in sports may need to focus on specific training to be able to regain sports activities. Gradual increase in intensity in exercises and activities is recommended to ensure proper rehabilitation and avoid injuries.
Fractured elbow in children also presents in a similar manner. Fractured elbow is more common in children and most of the uncomplicated fracture elbow may heal with non-surgical treatment.
Surgical Treatment for Fractured Elbow
Surgical treatment for fractured elbow is required in some cases when the fracture elbow causes shifting of bones and makes them move out of position. Most common cases include:
- Displacement or fractured elbow that makes bones move out of place. Triceps muscle of the upper arm, which is also connected to the olecranon of the elbow joint, helps to straighten the elbow. So this function can be regained only after the bones are put in place and appropriate rehabilitation is done.
- Open elbow fracture when the broken pieces of bone injure the skin surface. In such cases, the risk of infection is high and needs to be treated with antibiotics as well. Surgical treatment for such wounds includes cleaning of the wound and fixing the broken pieces of the elbow bone.
Following surgical repair for fractured elbow, it is important to follow rehabilitation and physical therapy as advised.
Prevention of Elbow Fracture
Elbow fracture can be prevented by taking necessary precautions while playing, travelling or when involving in adventure sports. Those with a previously injured elbow or those having sustained a fracture elbow, need to take special care and avoid further injuries. Some of the steps that can be taken include:
- Protect elbow joint by wearing braces, wrist guards, elbow pads when playing sports and use appropriate protective gear based on the activities involved in.
- Persons with fractured elbow need to avoid slippery floors, areas that have increased risk of falling, activities that demand high level of balancing and adventure.
- Preventing falls is important to protect elbow form injury. It is important to take appropriate measures to keep floors clean, usage of railings can help if there is difficulty in balancing or taking support when climbing up or down the stairs can help too.
- Sports persons, players and children need to perform warm up exercises before beginning with core sports activities and also perform stretches after activities.
- Performing strengthening exercises regularly and continuing suggested physical therapy, if any, can protect the elbow joint from further damage.
- American Academy of Orthopaedic Surgeons. (2022). Elbow Fractures in Children. https://orthoinfo.aaos.org/en/diseases–conditions/elbow-fractures-in-children