Elbow Fractures

What it is

Three bones meet at the elbow: the humerus (upper arm), the radius, and the ulna. Fractures usually come from a fall, a direct blow, or a twisting injury, and can happen with sprains or dislocations.

Types of elbow fractures

• Radial head and neck fractures: pain on the outside of the elbow, worse with turning the forearm. Simple fractures are treated with a brief splint or sling and early motion; complex ones may need screws, a plate, or a radial head replacement.
• Distal humerus fractures: usually involve the joint and need surgery with plates and screws. In older adults with fragile bone, elbow replacement may be better.
• Olecranon fractures: the tip of the elbow, which the triceps pulls apart, so these usually need surgery with wires, plates, or screws.
• Fracture-dislocations: including the “terrible triad” (dislocation with radial head and coronoid fractures) and Monteggia fractures (ulna fracture with radial head dislocation), which need surgery to restore the joint.

Symptoms

Pain, swelling, loss of motion, and sometimes a snap felt at the time of injury. Visible deformity may mean a dislocation. Numbness or discoloration of the hand is rare but needs urgent evaluation.

Diagnosis

X-rays first, with a CT scan or MRI for more detail when needed.

Treatment

Initial treatment is a splint, brace, or sling, rest, and medication for pain and swelling. Stable fractures are treated without surgery, and the elbow is unusual in that early motion of simple fractures is safe and helps prevent stiffness. Displaced or unstable fractures are more likely to need surgery, and open fractures need urgent surgery to clean the wound and bone. Rehabilitation with a therapist helps restore motion.

Children

Children's elbow growth plates can break in minor falls from playground equipment or trampolines. Casts are used more often in children, even for simple fractures, and more severe fractures may be held with temporary pins. Children are less prone to elbow stiffness than adults.