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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 usually result from a fall on an outstretched arm or direct force.

  • Fractures of the distal humerus may damage an artery in the arm, cause bleeding in the joint, or damage nerves that run through the elbow, causing numbness and problems moving the hand and fingers.

  • Doctors base the diagnosis on results of the physical examination and x-rays.

  • Treatment involves consultation with an orthopedic surgeon and splinting (when the bones have not moved out of alignment) or surgery (when the broken pieces are separated and/or out of alignment).

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.

Symptoms and Signs

The elbow area is painful and swollen. The ability to bend the elbow may be limited.

People may have bruises on their lower forearm. The bruises suggest that a blood vessel is injured.

The forearm and hand may be numb, and people may not be able to move their hand and fingers normally. These symptoms suggest that a nerve is injured.

Diagnosis

  • 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 : Diagnosis).

To determine whether there is a fracture, doctors take x-rays of the elbow joint from different angles.

If doctors suspect a distal humeral fracture but x-rays do not show one, they splint the elbow and have the person come back for additional x-rays, usually in 7 to 10 days.

If doctors suspect a fracture, they also check for damage to blood vessels and nerves in the arm. 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.

Treatment

  • 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 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. Most people are admitted to the hospital so that doctors can determine whether blood vessels or nerves have been damaged. However, if people agree to return for another examination the next day, they may be allowed to go home.

Typically, if the broken pieces are separated and/or out of alignment, surgery (open reduction with internal fixation, or ORIF) is done to realign and immobilize the broken pieces. 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.

  • Upper forearm (radial head) fractures usually result from a fall on an outstretched arm.

  • The elbow is swollen and painful.

  • Doctors take x-rays from different angles, but these fractures are often hard to see, so diagnosis relies heavily on results of the physical examination.

  • Most of these fractures can be treated with a sling, but some require surgery.

  • Range-of-motion exercises are started as soon as possible.

Radial head fractures usually result from a fall on an outstretched arm. They often occur in active adults. They are more common among adults than children.

Fractures in the lower end of the forearm bones are considered wrist fractures.

Symptoms

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.

Diagnosis

  • 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 : Diagnosis).

To check for this fracture, doctors take x-rays from different angles. But radial head fractures may be hard to see, so diagnosis relies heavily on results of the physical examination. However, x-rays usually show fluid inside the elbow joint if a fracture is present.

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

Treatment

  • Usually a sling

  • Range-of-motion exercises

  • For severe fractures, surgery

Most radial head 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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