A fracture (or break) to the elbow commonly occurs as a result of a fall on to the arm, a twisting injury or a direct blow. The elbow is made from three bones which are known as the humerus, ulna and radius. The anatomy of the elbow joint is complex and includes several ligaments that serve to stabilise the joint. These ligaments can be damaged at the same time as the fracture and sometimes the elbow may come out of joint (or dislocate). Osteoporosis, a disorder in which bones become very fragile and more likely to break, can make a relatively minor fall result in a broken elbow.
What are the symptoms?
This is usually made from the clinical history (the account of events and symptoms from the patient), clinical examination and X-rays. In some cases, special scans CT (computed tomography) or an MRI scan may be required to provide further information on the injury. An MRI scan can also be useful if an associated ligament injury is suspected.
The initial assessment and X-rays are usually undertaken in the Accident and Emergency Department. At the same time a temporary plaster cast or splint will be applied.
Types of elbow fracture:
Radial head or neck fracture
The radial head and neck is the cylindrical part of the radius bone at the elbow. The shape of the radial head allows for twisting movements of the forearm. The radial head sits within the capsule of the elbow joint. A fracture to this part of the elbow will often cause pain when rotating the palm of the hand upwards or downwards. Treatment will depend on what kind of break it is and how many fragments there are. If it is a complex fracture, the joint may need surgery to be repaired (with screws and /or a small metal plate), or if there are multiple fracture fragments the radial head may have to be removed or replaced (radial head replacement).
The olecranon bone forms the point of the elbow and is the part you often lean on. This part of the elbow forms the underside of the hinge joint which allows bending and straightening of the joint. A fracture to the olecranon can be treated in a plaster of Paris if non-displaced. Commonly, however they are displaced and require surgery to realign the bones with wires, plates, or screws.
Distal humerus fracture
The humerus is the bone in the upper arm. The humerus forms the upper part of the hinge joint at the elbow. A fracture to the humerus bone at or just above the elbow joint is more common in children and the elderly. The injury can be associated with nerve or artery damage. Undisplaced fractures can again be treated in a plaster of Paris. Complex or displaced fractures may require fixation with plates and screws or sometimes elbow replacement surgery.
What are the problems following an elbow fracture?
Stiffness, Arthritis, and Heterotopic ossification:
The elbow joint does not tolerate injury well and will often develop stiffness following a fracture. Most often this will be relatively mild but patients will often require a long period of rehabilitation under the guidance of the physiotherapist or hand therapy team. Occasionally surgery may be required with the aim of improving the stiffness, if significant difficulties with function occur.
If the fracture disrupts the elbow joint surface itself (intra-articular), there is a risk of developing post-traumatic arthritis of the joint. Elbow arthritis can develop relatively quickly or take many years following the injury as the joint cartilage wears away over time. This can cause pain and or stiffness, and may require further treatment depending on the level of symptoms (see elbow arthritis).
Heterotopic ossification (HO) is when new bone forms in the soft tissues around the elbow. This can occur rarely after injury or fracture or surgery. This can lead to stiffness of the joint as it produces a mechanical block to movement. Surgery, which is rarely needed, serves to remove the new bone but is generally delayed until the new bone has matured.