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Elbow Fractures

By Danielle Campagne, MD, Assistant Clinical Professor, Department of Emergency Medicine, University of San Francisco - Fresno

Elbow fractures may involve the upper arm bone (humerus) near the elbow—called distal humeral fractures—or the larger upper forearm bone (radius)—called radial head fractures.

Distal Humeral Fractures

(Supracondylar Fractures)

Distal humeral fractures occur in the lower part of upper arm bone (humerus), which is part of the elbow joint.

Distal humeral fractures often occur in children aged 3 to 11 years old. They usually result from a fall on an outstretched arm or direct force.

The fracture usually extends into the joint and may cause bleeding in the joint.

The main artery of the upper arm (brachial artery) may be damaged, particularly if the broken bones are separated (displaced) or out of alignment. When this artery is damaged, compartment syndrome may develop. As a result, the elbow and wrist may become a permanently stiff (called a contracture).

Sometimes nerves that run through the elbow (radial or median nerve) are damaged. When the radial nerve is damaged, people cannot cock their hand up. When the median nerve (the nerve that is compressed in carpal tunnel syndrome) is damaged, people may have difficulty pinching their thumb and little finger together.


  • A doctor's evaluation

  • X-rays

If people think they or a child may have fractured their elbow, the injured person should be seen by a doctor immediately.

Did You Know...

  • People who may have an elbow fracture should see a doctor immediately.

Doctors ask people to describe what happened and what their symptoms are. Doctors also examine the elbow (see Overview of Fractures, Dislocations, and Sprains : Diagnosis).

To determine whether there is a fracture, doctors take x-rays of the elbow joint from different angles. Then they gently move the joint. Moving the joint can help doctors determine the severity of the injury.

If doctors suspect a fracture, they also check for damage to blood vessels and nerves in the arm (see Neurologic Examination : Motor Nerves). For example, they check the pulse at the wrist to determine whether blood flow to the hand is normal. To check whether a nerve is damaged, they ask the person to move the fingers and hand and ask whether the person can feel things with the fingers.


  • Consultation with an orthopedic surgeon

  • Usually surgery to realign the broken bones

  • Rarely only a splint

An orthopedic surgeon is usually consulted because these fractures often involve the nerves or blood vessels and can cause long-term problems.

If the bones have not moved out of alignment, a splint can be used to immobilize the broken bone. However, children are often admitted to the hospital or are asked to return for another examination the next day to make sure there is no blood vessel or nerve damage.

Typically, if the broken pieces are separated and/or out of alignment, surgery (open reduction with internal fixation, or ORIF) is done. Because aligning the broken pieces (reduction) can damage nearby nerves and blood vessels, surgery is usually done by a specialist.

Fractures of the Upper Forearm

(Radial Head Fractures)

Upper forearm fractures can occur in the top (head) of the larger forearm bone (radius), which is part of the elbow joint.

These fractures (called radial head fractures) usually result from a fall on an outstretched arm. They often occur in active adults.

Fractures in the lower end of the forearm bones are considered wrist fractures (see Wrist Fractures).


Moving the elbow is painful, and one side of the elbow is tender when touched.

Blood may leak into the elbow joint, causing swelling. Often, people cannot fully straighten their arm.


  • A doctor's evaluation

  • X-rays

Doctors ask people to describe what happened and what their symptoms are. Doctors also examine the elbow (see Overview of Fractures, Dislocations, and Sprains : Diagnosis).

To check for this fracture, doctors take x-rays from different angles, but radial head fractures may be hard to see. However, x-rays usually show fluid inside the elbow joint, suggesting that a fracture is present.

Doctors also gently try to move the elbow to determine whether ligaments are affected.


  • Usually a sling

  • Range-of-motion exercises

  • For severe fractures, surgery

Most of these fractures can be treated with a sling (see Figure: Commonly Used Techniques for Immobilizing a Joint). If the fracture is severe, surgery is done.

Exercises to move the elbow through its full range of motion are started as soon as people can tolerate them (often after a few days). These exercises can prevent permanent stiffness.

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