Download Information leafletFractures and dislocations of the elbow
What is it?
Fractures around the elbow involve three bones – the upper parts of the two forearm bones (radius and ulna) and the lower part of the arm bone - the humerus.
What is its cause?
Injuries and fractures to the elbow are common. The elbow may fracture after a fall onto an outstretched arm, a direct impact to the elbow, or a twisting injury.
What are the symptoms and how is the condition diagnosed?
Immediate pain is felt around the elbow. The elbow will immediately swell and bruise. The elbow will be deformed if the fracture is significantly displaced or associated with a dislocation. The patient will not be able to move the shoulder.
X-rays: The diagnosis of these fractures can only be confirmed by an x-ray. The pattern of fracture seen on the x-rays will determine the treatment. The x-rays will show the Specialist how much the bones have moved apart (displaced), whether the fracture extends into the joint (intra-articular), and the number of bone fragments (comminution).
Sometimes patients may also sustain a wound and the fracture is called an ‘open fracture’. Open fractures are treated urgently to prevent further soft tissue damage and infection.
Symptoms like tingling, numbness and discolouration suggest pressure on the nerves or blood vessels. The presence of pulse at the wrist should be noted.
Will further tests or investigations be needed?
In addition to the initial x-ray, your specialist may, in certain cases of elbow fractures, advice further investigations (usually CT) before planning treatment.
What is the treatment for acute fractures?
The general principle in treating an elbow fracture is to reduce the displaced fracture and hold it in place. An adult elbow usually becomes stiff after an injury and early mobilization of the elbow is extremely beneficial. The method by which this can be achieved is dependent on the location of the fracture; if the fracture extends into the joint; the degree of fracture displacement; the extent of comminution (fracture fragments); the quality of bone stock and the functional demands of the patient. If it is an open fracture the wound needs to be cleaned, debrided and the fracture fixed urgently.
- Conservative treatment in a sling:
This is the conventional treatment of relatively undisplaced elbow fractures. It is practiced in fractures that occur after low energy accidents, are minimally displaced or in those patients in whom anaesthesia or surgery will carry a greater risk. The arm is put in a sling for 1-3 weeks but also mobilized as comfort allows. - Surgical treatment by fracture reduction and internal fixation:
Surgery is needed for open fractures; unstable fractures (significantly comminuted, shortened or displaced); fractures with associated nerve problems; or for patients who have sustained multiple fractures. Unstable fractures around the elbow in adults, will generally be treated with surgery followed by early motion.
Closed reduction and K-wire fixation:
Under anaesthesia the fracture is reduced and then held but 2-3 pins (k-wires). The K-wires are not strong enough to hold the fracture by themselves and the elbow still needs to be supported for a few weeks. This technique is usually used for fractures in children, as the risk in developing elbow stiffness is very small.
Open reduction and internal fixation: There are multiple techniques by which open reduction and fixation of the fracture can be achieved. The techniques are determined by the nature and location of the fracture (see x-rays below).
Elbow replacement: It may not be possible to reconstruct some elbow fractures. In such circumstances, elbow replacement is considered, especially in the elderly. Similarly, comminuted fractures of the radial head are also replaced.
What happens if it is not treated?
If appropriate advice is not sought for these fractures, the fractures may heal with a deformity. Significant elbow stiffness will follow. Intra-articular fractures will soon lead to elbow arthritis.
What is the success of treatment?
Properly treated elbow fractures will result in success. Recovery can take a long time, especially in high-energy injuries, because there has been significant soft tissue damage. The aim of surgery is to regain functional range of motion and strength. It is likely that some range of motion may be lost.
What are the complications of treatment?
- Infection of the wound is possible and can usually be successfully treated with antibiotics.
- Elbow stiffness and poor strength.
- Unsightly scar.
- A patch of numbness around the scar.
- Nerve or blood vessel damage.
- The implants may cause problems and need to be removed (olecranon fractures).
- The bones may still fail to unite after surgery.
- If the elbow has to be replaced, it may fail in the long-term. If this occurs, the replacement will need to be revised.
- Any surgical intervention has the risk of developing complications that are unpredicted. These complications may have the potential to leave the patient worse than before surgery.
Is there anything I can do to improve the outcome?
Keep the wounds dry and clean until they have healed.
After the operation the therapist will see you and start movements of the elbow. It is important to do the prescribed exercises regularly both during the physiotherapy sessions and at home. It will help to keep the pain levels down with analgesics so as to keep your shoulder, elbow and hand fingers moving.
It is advised against wearing rings on the operated side for 4-6 weeks after surgery.
When can I do various activities?
Return to work depends on many factors including the nature of the job, hand dominance and the nature of your fracture. The advice will vary individually and this is best discussed with the Specialist.
