What is an elbow fracture?
An elbow fracture is a term for a break in the bones that contribute to form the elbow joint. The Elbow joint itself is formed by the union of three bones, the far end of the humerus (the upper arm bone) and the radius and ulna (the forearm bones). The end of the ulna known as the olecranon process (the boney point at the back of your elbow) hooks into the back of the humerus creating what is known as a hinge joint named as such as it only moves in flexion and extension. The radius connects both to the humerus and the side of the ulna via the radial head. The joints between the radius and ulna allow you to pivot your hand and forearm from palm upwards to palm downwards actions known as supination and pronation. The fractures most commonly referred to as elbow fractures are fractures to the olecranon, radial head or neck, epicondyle (two large rounded boney prominences at the end of the humerus on the inside and outside aspects of the elbow) and humerus shaft fractures very close to the elbow.
Why & when does an elbow fracture happen?
Elbow fractures are very common in both the older and younger population and are normally the result of a crush trauma like a car accident, a direct blow to the elbow or high impact from falling onto an outstretched hand. It is instinctive to put your hands out to save yourself when you fall but this means that your wrist and elbow impact the hard floor with your body weight behind it which in many cases is too much strain for the thin forearm bones to bear. This action normally results in radial head and neck fractures or distal humerus shaft fractures. Falling backwards and landing on the tip of your elbow also causes enough strain to fracture the olecranon. These injuries are often seen in athletic sports where falls are common such as cycling, running, ice skating, skateboarding and snowboarding but it is more commonly seen in the very young and very elderly as falls are more common at these ages. A direct blow to the arm from a heavy object is normally responsible for epicondyles. Minor injuries like mild falls and mild knocks to the elbow can result in an elbow fracture, this typically only happens when there is an underlying bone weakening condition like osteoporosis. Elbow fractures are classified into closed fractures where there is no injury to the skin of the elbow and open fractures where there is an open wound as a result of the fracture. Due to the risk of damage to the surrounding arteries, nerves and tendons elbow fractures are considered a medical emergency.
What to do if an elbow fracture is suspected after trauma?
If you suspect someone has sustained an elbow fracture after any type of trauma then you must immediately call for medical help. As mentioned previously most people injured by high impact accidents may have sustained other injuries as well as the fracture making medical attention vital. It is important to make sure the individual is safe and comfortable If the patient is otherwise unharmed it may be advisable to escort them to A&E if there is the possibility of other injuries then it is advisable to wait for medical help. On arrival paramedics will check the patient over, stabilise the arm, normally with a sling before taking the patient to accident and emergency.
What does an elbow fracture feel like?
An elbow fracture from trauma causes a very intense immediate sharp pain around the fracture site this pain can radiate up into the upper arm, shoulder and down the forearm into the wrist and hand. The fracture is often accompanied by swelling and bruising and aggravated by most arm or hand movements this makes weight bearing or lifting with the effected hand excruciating. Patients will instinctively cradle their fractured arm in their good one keeping it immobilised and close to their body. The intense pain after a break will last for several hours which will be aggravated or prolonged by any treatment options like manipulation or traction. Post-surgery or after treatment when the bone starts to heal there will be a dull continuous ache from the swelling and healing process that will last weeks to months. During the healing process the bone is trying to knit together and re-unite this stage can be quite painful and it is very important to rest through this stage to ensure that the bone reconnects properly. The soft tissue surrounding the fracture also starts to form scar tissue to bind everything together allowing the structure to try and restore its original state and function.
How will an elbow fracture be diagnosed?
Patients will be taken to A&E and a full examination will be done to rule out any additional injuries or complications like nerve damage or infection. Your doctor will order an X-ray of the elbow including a good portion of the arm and forearm to confirm the diagnosis and identify the location and the extent of the fracture. Occasionally if the extent of the fracture isn’t fully visible on an X-ray then an MRI or a CT scan will be ordered as this will give a more detailed view of the fractured site. Doctors will also use an MRI scan to assess whether the pain felt after trauma is coming from injury to the surrounding muscles, ligaments or joint capsules and not indeed from a fracture. The occurrence of an elbow fracture from mild trauma may prompt doctors to investigate for any underlying bone weakening conditions.
What treatment options are available for elbow fractures?
The treatment options and healing times for elbow fractures varies depending on the position and severity of the fracture and also on the complications from any additional injuries like infection with open fractures. Most cases of elbow fractures do not need surgery however it is occasionally necessary to surgically stabilise multiple fractures or some severe complete breaks. Traction or manipulation may be used to correct the position of the fractured bone and a splint or a cast will be used to reinforce and stabilise the fracture until it is well healed. Patients will initially have to rest and avoid weight bearing or lifting with that arm whilst recovering. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. An elbow fracture can take anything from 8 -12 weeks to heal if not longer for more severe breaks. Patients will be referred through to a physiotherapist who will provide exercises to strengthen upper arm and forearm muscles to aid the healing process. Fluctuating pain levels will be experienced throughout the healing process however most of the discomfort towards the end of the healing process comes from stiffness levels caused by long term immobility. The rehabilitation exercises as well as massage and some manipulative therapies can aid in recovering your elbow and arm flexibility.