Elbow Fracture

About the elbow

An elbow fracture is quite common in both adults and especially in children, accounting for about 10% of all childhood fractures.

The elbow is a joint in your arm made up of three bones:

• The humerus (a single bone that runs from the shoulder to the elbow)
• The radius and ulna, two forearm bones that run from the elbow to the wrist.

Elbow is a complex joint that allows different movement such as bend and straightening of the arm (flexion-extension), but also the rotation of the forearm with palms up and down (pronation-supination).

Elbow injuries can damage the bones and other structures of your elbow, such as ligaments, blood vessels and muscles. This may cause problems with movement, blood vessel function, and nerve function.

When an elbow fracture occurs in children it may affect bones growth and development.

What may cause an elbow fracture

An elbow fracture can occur in different ways:

• Overuse
• Trauma during sport activity, like a fall backwards off a snowboard
• Trauma due to a car or motorcycle accident.
• A fall from a bike or from a skateboard with a direct blow on the elbow, on an outstretched arm, or directly on the elbow

Types of Elbow fracture

There are different types of fracture depending on the part of the elbow that is injured.

Supracondylar fracture:

Supracondylar means above the elbow.

It is the most common elbow fracture and occurs in the humerus, just above the elbow.

Condylar fracture

Condylar means at the elbow.

This type of fracture occurs through one of the bony knobs (condyles) at the end of the upper arm bone and involves also the joint surface.

Most occur through the outer, or lateral, knob.

Epicondylar fracture

This elbow fracture occurs at the top of each bony knob where there is a projection called epicondyle.

It may occur at either tip of the bony prominences on the inside, medial and outside of the elbow.

Growth plate (Physeal) fractures.
These fractures occur through the growth plates, that are areas of cartilage near the end of each bone (humerus, radius, or ulna).

These fractures, if not treated promptly and correctly can lead to a deformity in the bone and can also arrest its growth.

Fracture dislocation (Monteggia fracture)

A fracture of the ulna associated with a dislocation of the radial head (the top of the radius near the elbow).

Fractures can always be open, when a broken bone breaks through the skin. They are called open fractures and since they may involve also damage to the muscles, tendons, and ligaments, they take a longer time to heal.

Broken elbow symptoms

An elbow fracture may have the following symptoms:

• acute pain that doesn’t get better
• swelling
• deformity of the elbow
• difficulty moving the elbow
• bruising or redness around the elbow
• numbness and tingling in the forearm, hand or fingers. (this is the case of more severe injuries that may have affected major nerves or blood vessels.
• In case of an open traumatic fracture, there may be an open wound or a cut through the skin

Elbow fracture examinations and tests

A suspected broken elbow needs physical examination by an orthopaedic surgeon.

The doctor will discuss symptoms, medical history and will perform a physical examination of the injured arm looking for the typical signs and symptoms.

During the examination it will be important to test also nerves and circulation, trying to gently move the arm and its joint.

Imaging tests

Usually, X-rays of the elbow and sometimes of the forearm are enough to diagnose an elbow fracture.

MRI, ultrasound and arthrogram are rarely needed.

Broken elbow treatment

Treatment for an elbow fracture depends on the severity of the injury and the degree of displacement.

Nonsurgical treatment

If the fracture is not compound and the bones are still lined up well, the orthopedic surgeon may recommend a cast or splint for about one month.

Closed reduction

Sometimes the orthopedic surgeon may need to reposition the bones – manipulation under general anaesthesia – before applying the cast or splint.

In this case, he or she will gently manipulate the bones moving your arm to bring them back into place.

Surgical treatment

If the bones do not line up correctly surgery may be needed and pins, screws, or wires are required to hold the bones together in the correct position for about a month while they heal.

After surgery, a cast or splint is often used, as well.

Outcome and recovery

Generally, the long-term outcome is excellent in most cases with the elbow’s range of motion that returns to normal.

The arm is usually placed in a cast or splint from 3 to 6 weeks, whether the fracture has been treated with surgery or not.

After that, physical therapy is very important for a full recovery.

The doctor may suggest you some specific exercise to regain a full range of motion.

Elbow fracture prevention

To help reduce the risk of an elbow injury it is important to wear protective elbow guards and pads in particular during sport activities such as snowboard, skating, skiing, biking.

Prof. Nicola Portinaro’s experience.

Prof. Portinaro is has been treating elbow fractures both with a surgical and non-surgical approach for more than 30 years.

He examined more than 1000 children with an elbow fracture or dislocation mainly due to sport injuries such as snowboard, biking, skateboard…

He has personally performed more than 150 surgeries both in adults and child  with different techniques