Elbow fracture


What is an elbow fracture?

A fracture of the elbow is the fracture or injury of at least one of the bones that form the joint between the humerus (upper arm), ulna and spoke (elbow).

The elbow joint performs an important task when lifting weights, dressing, washing, combing and working.

Possible injuries can occur on the humeral joint heads, radial head and epicondyle, as well as intercondylar or supracondyle.
Fractures of the olecranon (upper edge of the ulna) account for about 10% of elbow injuries and mainly affect adults. The ulnar nerve can be injured.
In general, fractures of the radial head are caused by a fall on the outstretched arms, that is, by indirect trauma.
Supracondylar fractures cause lateral displacement of the distal epiphysis of the humerus, often affect children due to direct trauma and are dangerous due to possible injury to the radial nerve.
Injuries to the humeral joint heads are rather rare.

In the case of falls of older people, the likelihood of a wrist fracture is much higher, which is why an elbow fracture is less common in people over 65 years of age.
It usually occurs unilaterally either on the right or on the left.
In severe cases, in addition to the fracture, there may also be a dislocation, for example, a Monteggia fracture consists of a fracture of the ulna and a dislocation of the spoke.

What are the causes of elbow fracture?

X-ray of a broken elbow, in which the pineal gland of the spoke appears slightly torn.
Causes of elbow fractures are direct or indirect trauma with bent elbow.
They occur in motorcycle accidents and bicycle falls with bent and supinated elbows or in a strong impact, such as a fall from the first floor.
Slipping backwards (for example on the snowboard) is more likely to lead to an elbow fracture.

How are elbow fractures classified?

Injuries to the elbow can occur supracondylar, intercondylar or on the radial head. This depends on whether they occur above the humeral joint heads, in between or on the spoke.
According to the Mayo Clinic, radial head fractures at the elbow can be divided as follows:

  • Type I: not displaced or with a diastasis (removal) of the fractures of less than 2 millimeters, the healing prognosis is good.
  • Type II: with or without debris, accounts for 80-90% of elbow fractures, the prognosis for recovery is quite good.
  • Type III: displaced and unstable, also here a debris fracture may or may not be present, usually occurs in conjunction with an injury to the spoke head.
    They are very rare and account for around 5% of fractures. Recovery times are prolonged and the prognosis for recovery is cautious.

What are the symptoms of an elbow fracture?

The patient comes to the emergency room with severe elbow pain and swelling of the injured area with a visible hematoma.
Moving the arm is almost impossible due to the pain, so functionality is almost completely limited.
In the case of a displaced fracture, a depression above the olecranon can be perceived with an elbow bent to 90°.
If the injury is severe, the ulnar nerve (elbow nerve) may also be injured. The result is a series of symptoms on the ulnar side of the wrist, in the little finger and in the ring finger.

Which diagnostic examination is best suited for an elbow fracture?

The most suitable examination for fractures is X-ray. For the elbow joint, the elbow must be bent at right angles and the image must be taken in lateral projection.
With the elbow outstretched, it is not possible to see whether the fracture is displaced and whether the fragments fit together.

Diagnosis of elbow fracture

The doctor reviews the medical history, the way the trauma came about and the signs and symptoms of the patient; if he suspects a bone fracture, he prescribes an X-ray and conducts clinical tests.
When examining the patient, some deformations can be detected, which indicate a displaced fracture. In fact, in an olecranon fracture, the triceps tendon pulls the bone fragment towards the shoulder, causing a highly visible elbow misalignment.
The most suitable test is the extension of the elbow. If the patient does not succeed, there is a 50-60% chance that a fracture is present.
If the patient can fully stretch the joint, an X-ray can be dispensed with. However, the patient should continue to be observed in the week after the accident, because if the pain persists, there could be a small injury.
Magnetic resonance imaging is rarely performed. This examination has the advantage that it also shows a microfracture. However, this type of fracture heals spontaneously over the course of around 2 weeks.

Which therapy is suitable for an elbow fracture?

Non-displaced fractures are treated by fixation using a plaster cast or orthosis over a period of about 30 days. If the subsequent X-ray control does not yet show the beginning of callus formation, the bandage must be worn for another month.
Children may wear plaster casts for a maximum of 15 days.
With a displaced fracture of the humeral joint head, the broken fragment moves in the direction of the hand; the orthopedist must decide whether to remove the fragment or fix it with the spoke using a metal nail.
If the displaced fracture is epitrochlear or occurs at the level of the epicondyle, the fragment shifts significantly. Then the fracture must be repositioned and fixed with a metal nail.

An olecranon fracture is also treated with surgical intervention, as the triceps tendon often keeps the fracture offset and thus prevents consolidation. In this case, a border made of Kirschner wire is used to hold the fragments in the correct position. Then the whole thing is fixed with a metal plate.
Kirschner wires are not simple fiber threads, but small metal wires made of stainless steel, which are bent with pliers.
The edging serves to counteract the forces that tend to pull the bone fragments apart in order to compact the fragments among themselves.
If it is a debris fracture that cannot be repaired with surgical intervention, the surgeon may insert a bone graft from the tissue of the fibula.

Often side effects (medium to long-term consequences) of the rupture remain. Often the mobility of the elbow can not be restored to 100%. The radial or ulnar nerve can also be injured.
If the patient feels severe pain, the doctor may also prescribe medications such as nonsteroidal anti-inflammatories. However, it is better to use analgesics, since inflammation is a body reaction that favors the reconstruction of the elbow and therefore should not be hindered.

Complications of an elbow fracture

  • Stiffness. In the case of a displaced and multiple fracture, diffraction and stretching are only possible to a limited extent.
  • Arthrosis. Degeneration of cartilage and joint can cause pain and chronic inflammation.
  • Chronic instability. The elbow is not stable and can dislocate.
  • Pseudarthrosis or poor coalescence. The fragments do not grow together or grow together in an unnatural position. This complication is especially evident if the fracture has not been treated. If the fracture has not healed after a few months, you can work with shock waves that stimulate reconstruction.
  • Infection, especially with open fractures.
  • Injuries to arteries and nerves, especially the ulnar nerve, which can be pinched by fibrous post-traumatic scar tissue. Symptoms include elbow pain to the fingers, tingling, loss of strength and sensitivity from the elbow to the little finger and ring finger.

What rehabilitation takes place after an elbow fracture?

Elbow fractures must be treated as soon as possible to regain mobility. The most difficult thing is to regain full flexion and extension.

The first part of physiotherapy consists in the application of magnetic therapy to promote callus formation of the bone. It can also be performed on operated patients and even with a plaster cast attached.
As soon as possible, you should start with exercises for passive rehabilitation and assisted passive rehabilitation in order to recover as well and quickly as possible.
To speed up healing, you have to work hard both passively and actively.
As soon as the pain allows, you should start building muscle.

How long does it take to heal? Prognosis

Recovery times depend on:

  • the severity of the fracture,
  • the complications,
  • the age of the patient,
  • other diseases from which the patient suffers.

With a non-displaced fracture, a young person can fully recover within 2-3 months, while in an elderly person it often takes 3-4 months.
If it is a complicated fracture with many fragments, complete healing will take more than 6 months, but the patient will no longer be able to fully bend and stretch the joint.
The full range of motion is rarely necessary in daily life. Therefore, patients can mostly live as before and also lift weights.

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