Elbow Fractures

Elbow fractures are complex injuries.  These fractures can vary significantly in severity, with many of these injuries requiring surgery to restore normal elbow function.

Anatomy and Causes

The elbow joint is a complex joint consisting of three bones: the humerus, the ulna, and the radius.  There are actually three separate articulations within the elbow joint, each contributing to the stability and normal motion of the elbow.  The joint between the distal humerus and the ulna, termed the ulnohumeral joint, functions as a hinge.  The joint between the distal humerus and the radius, termed the radiocapitellar joint, allows rotation of the forearm.  Finally, the joint between the proximal radius and ulna, termed the proximal radioulnar joint (PRUJ), allows the radius to rotate around the ulna in forearm rotation.  

There are also a complex set of ligaments around the elbow that stabilize the elbow joint while allowing for appropriate motion between these three bones.  

Elbow fractures can occur by a number of mechanisms, including falls directly onto the elbow or with rotational injuries which may cause elbow dislocations.  These injuries can involve fractures to one or more of the bones of the elbow.  Distal humerus fractures, radial head fractures, and proximal ulnar fractures are all specific types of elbow fractures.  In addition, the stabilizing ligaments around the elbow may also be injured in elbow fractures.

Symptoms and Associations

Elbow fractures are associated with significant pain, swelling, and loss of motion in the elbow.  These injuries can be associated with elbow dislocations as well as injuries to the wrist or shoulder.  There are also several nerves and blood vessels that cross the elbow – while uncommon, it is also possible for these to be injured with severe elbow trauma.

Treatment

Treatment of elbow fractures is focused on establishing fracture stability to allow for early elbow range of motion.  Prolonged elbow immobilization results in severe elbow stiffness which may be permanent.  Because of this, prolonged immobilization in a cast or splint is generally not an option.  Because of this, many fractures about the elbow require surgical fixation to allow for early motion.

Non-operative

Non-surgical treatment for elbow fractures is limited to a small set of fractures.  For a fracture to be treated nonoperatively, it must not disrupt the stability of the elbow joint and must be in acceptable alignment.  

Operative

Many elbow fractures require surgery to allow for early motion.  The specific surgery depends on the bones fractured and the pattern of those fractures.  Most fractures are treated with open reduction and internal fixation, meaning the bone is put back in place and fixed with plates and screws.  Injury to the ligaments around the elbow may also require surgery to restore stability of the elbow.  Some fractures may require the replacement of all or part of the elbow joint.

Elbow surgery is usually done as an outpatient surgery without needing to stay overnight in the hospital.  Your surgeon may place your elbow in a splint after surgery.  This is usually removed within 1-2 weeks to start range of motion of the elbow under guidance from one of our hand therapists.