Elbow fractures happen quite frequently, and they can be extremely painful. They’re especially common in children. In fact, according to the American Academy of Orthopaedic Surgeons, 10% of the fractures kids get are elbow fractures.
There are a few different kinds of fractures involving the elbow. We’re going to look at what these are, what symptoms you’ll see from the various types, and what the treatments are for each. We’ll also discuss what things usually cause fractures to the elbow, so you’ll know how to try to avoid and prevent them.
The Anatomy of the Elbow
Let’s first go over the anatomy of the elbow so when we discuss the types of fractures it will be easier to understand what happens with the injury.
The elbow is a joint in the center of each arm. There are three bones included in the joint. Here’s a quick look at each of them:
- Ulna – This is a bone in the lower part of the arm called the forearm. It’s located toward the outside of the arm on the side the pinky finger is on. It connects the elbow to the wrist. The olecranon is a part of the ulna. It’s the part of the elbow you can easily feel and see under the skin. It scoops around the end of the humerus and creates the hinge so the arm can move at the joint.
- Radius – This is another bone in the forearm. It’s on the inside of the arm towards where the thumb is. It also runs all the way from the elbow to the wrist. The radial head is the end of this bone where it comes together with the elbow. It moves back and forth and rotates when you move your arm in various ways.
- Humerus – The humerus is in the upper arm. This bone connects the shoulder to the elbow. The end of it is called the distal humerus. It makes the top portion of your elbow and provides the rod for your forearm to pivot around when you bend it or straighten it.
There are ligaments and muscles that hold everything together. There are also three large nerves that cross over the elbow.
Causes of Elbow Fractures
There are endless possibilities for scenarios of things that could potentially break your elbow. Generally though, a fracture in this part of the arm is caused by one of three things. Either:
- You fall straight down on or bang something directly with your elbow.
- Something hits your elbow head on. This could be a football helmet, a wall, a car door in an accident, or any number of other things that are made of hard materials.
- Falling when your arm is completely extended. Usually, when you have your arm in this position, everything is flexed and being held tightly. This sometimes causes a piece of the bone to get pulled off of another bone, usually the ulna.
As we mentioned above, there are a lot of these fractures seen in children. Kids typically do a lot of physical things like riding bikes, scooters, skateboards, running and jumping outside, playing on playground equipment, and more. These activities just open the door more frequently for elbow fractures in children who also tend to have less awareness about how to look out for potential injury-inducing situations.
Types of Elbow Fractures
Not all elbow fractures are the same. The kind of fracture you end up with will depend on what causes it. You could end up with fracturing on the top, the bottom, the front, or the back. You might have a break that’s spiral, straight, slight, or severe. All aspects of the fracture are considered to determine what type of break you have.
This is a fracture that is located in the humerus, so above the elbow. Of all of the kinds of breaks that can happen involving the elbow, this is the one you see the most. It also happens most often to kids who are pretty young, usually under eight years old.
These are fairly common for young kids, but they’re something you should try to avoid. They can cause some serious damage for children because of the major nerves that run over the location. There may also be problems with circulation resulting from this kind of break.
This kind is a break on the inside part of the elbow tip. There is a knob of bone called the epicondyle that pokes out from the joint. When a fracture occurs to the inside of the knob, this is called an epicondylar fracture. It’s seen most often in children that are 9 to 14 years old.
The bottom of the humerus has knobs known as condyles. When the bone breaks right there, it’s called a condylar fracture. There are multiple knobs, but most of the time the lateral or outer knob is the one that breaks. Treatment for these can be a little more complicated due to the presence of the physis (growth plate) and because this is where the surface of the joint is.
You can have a fracture that causes the head of the radius bone to get pushed out of place. These are quite painful and not as common as some of the others.
If you fracture your ulna and it causes the head of the radius to become dislocated, it is known as a Monteggia fracture. When this happens, it’s highly important that the dislocation is discovered. Sometimes it gets missed, which results in a decrease in the functionality of the elbow joint overall.
This is a very severe fracture where one or more bones break through the skin. It can cause many other issues to arise, such as muscle problems, tendon and ligament damage, and longer healing processes.
How to Recognize an Elbow Fracture
The good news is elbow fractures are fairly easy to recognize. Regardless of what type of fracture it is, they usually present the same symptoms. Here’s what you need to look for:
- Extreme pain in the elbow, the forearm, or both
- Swelling at the elbow
- Lack of feeling in the hand
- Loss of functionality of the elbow, cannot straighten out the arm
This kind of injury should not be dealt with on your own. It’s critical that anyone who has potentially fractured an elbow see a doctor as soon as possible. There is a risk of permanent damage if the injury is not properly tended to.
Treating an Elbow Fracture
For the majority of these breaks, there won’t be a need for surgery. However, in some cases it will be necessary. What’s important is that a doctor make that call so the injury will heal the way it should. Below are the possible treatments that may be needed to care for an elbow fracture.
The doctor will start by physically examining the injured area. He or she will look at it and feel for things like tenderness, numbness, or bumps. If the doctor diagnoses an elbow fracture or a determination can’t be made, the next step will be to get an X-Ray done.
The doctor needs to know what the extent of the break is. Also, he or she needs to see if there is a displacement of the bones or if the ends have angulated in relation to one another.
If the patient is a child, there may be X-rays done on both arms because there needs to be something to compare the injured one against. The reason for this is that the bones are not fully developed.
Treatments without Surgery
There are a few different methods for treating elbow fractures without surgery.
- Splints – These don’t provide the amount of strength and support that casts do but they leave room for any swelling that may occur or have occurred. Then, they can be adjusted very easily to accommodate the different levels of swelling you may have. Often, a splint will be used before the casting process because it allows for the swelling to go down before putting on the cast.
- Casts – These are used when it’s important that the bone pieces not move around so they can heal. They immobilize the arm so that the bone can heal itself without any further damage being done.
- Closed reduction – This is a process that usually happens before a splint or cast is put on. It’s what is done to reposition the bone pieces so that they will be able to heal properly. Many times there will be some sort of anesthetic given before the doctor makes any movement on the bone.
- X-rays – After the patient has had any of the above treatments, there may be times when the doctor will want more X-rays performed. It’s important that the healing process is monitored in this way, so the bone doesn’t mend improperly.
Treatments with Surgery
When an elbow fracture is a full displacement of the bone, there can be cause for surgery to put the pieces back into alignment, so they heal correctly. Sometimes there will be hardware used to hold everything in place.
One option is the closed reduction and percutaneous pinning. The procedure starts with a closed reduction like what we discussed above. The doctor moves the bone back into place first. Then, a series of metal pins are used to hold the bone in the realigned position by going through the skin and into the bone. They will bridge the gap between the fragments of bone pulling it together.
Once everything is in place, the arm will be put into a splint for about a week or so to allow for any swelling. After that, a cast will be applied. Usually the cast is only needed for a few weeks. When the bone starts to heal itself, a determination will be made to take the cast off and the pins out. The doctor just needs to see that the healing process is started so the bone pieces won’t be moving back out of place for the rest of the time that is needed to fully heal.
Another option is an open reduction with internal fixation. These are typically performed for open fractures. The bone fragments have to be put back into place through an open reduction. The other reason this procedure would be used is when there is nerve damage involved or some type of vascular injury that needs repairing.
What Does Recovery Look Like with Elbow Fractures?
Different levels of severity will result in differing timelines for recovery. However, you can count on that a splint or cast will probably be on the arm for anywhere between three and six weeks. And that’s with or without surgery.
Once the healing process has finished, some patients will be done and just move on. For others, the treating doctor may request them to move forward with some exercises or physical therapy. This will ensure a better chance at normal functionality and range of motion. Most of the time things will get back to normal eventually.
Stiffness can develop. You might not have the same level of functioning in the elbow joint anymore. You could have trouble with extending it all the way or turning it in certain directions. In some cases, specific exercises can help with this.
Arthritis could become an issue in the joint as well. It can be a lot like stiffness but with pain also. The elbow joint will be inflamed causing the pain and less mobility. It happens more when the injury is to an adult.
Nonunion or malunion could cause a problem. Nonunion means the bone fragments don’t fuse back together. Malunion means they do but not in the right way. There may be a bump or dent that’s visible on the outside. Surgery could be needed to fix either of these.
Elbow fractures should not be taken lightly. A doctor’s expertise is needed to ensure proper healing. Most of these injuries will heal though with the right treatment. So, if you experience an unfortunate accident resulting in one of these, don’t worry, it can be fixed.