Elbow Fracture

What is an Elbow Fracture?

Elbow fractures typically occur due to falls, blunt force trauma, or twisting injuries. Depending on the severity, elbow fractures can be treated with either surgical or non-surgical options. These fractures, occurring at the tip of the elbow, are categorized into different types.

Types of Elbow Fractures

Elbow fractures are generally classified into three main types.

Olecranon Fractures

The pointed tip of the elbow is known as the olecranon. It is part of the ulna, one of the two bones forming the forearm. The olecranon is not covered by muscles, leaving it unprotected and highly susceptible to fractures.

Radial Head Fractures

The radial head, which joins with the humerus (the upper arm bone), can fracture if pushed against the humerus. Radial head fractures, which account for 20% of elbow fractures, often result from falling on the elbow. These fractures, also known as radial head fractures, are more common in women, particularly between the ages of 30 and 40. Elbow dislocations often result in radial head fractures.

Distal Humerus Fractures

Fractures in the distal humerus, the bone connecting the shoulder to the elbow, are rare. They usually occur due to trauma or a fall on a bent elbow. Although distal humerus fractures make up 30% of elbow fractures, they only occur in 1-7% of adults. These fractures can range from minor cracks to complex fractures. Distal humerus fractures are further categorized, with intercondylar fractures being the most common.

A major drawback of distal humerus fractures is the potential for nerve injuries, particularly to the anterior interosseous branch of the median nerve. These nerve injuries typically resolve within 5-6 months without requiring treatment.

Diagnosis of Elbow Fractures

To diagnose an elbow fracture, the patient's symptoms are first assessed, followed by a comprehensive physical examination. X-rays are used to fully understand the condition of the elbow. Depending on the patient's symptoms, the forearm, shoulder, and wrist may also be examined on the X-ray.

For proper treatment, it is important to determine the fragmentation and location of the fracture. Therefore, elbow fractures are classified into categories.

Type 1

These fractures typically appear as cracks with no displacement of the bone fragments. This classification is used to describe the elbow's condition before reaching the point of fracture. Although there is structural damage to the bone, the fragments remain attached to the main bone, and short-term use of a splint is sufficient for treatment.

Type 2

In Type 2 fractures, small fragments break away from the bone, or there is a single fracture. Type 2 fractures are often seen alongside radial head fractures, sometimes leading to minor dislocations. Treatment typically involves the use of a sling or splint for 1-2 weeks, along with mild elbow exercises to aid recovery.

Type 3

Type 3 fractures are unstable, with bone fragments completely displaced from the fracture line. Nerve and tissue injuries are also common in Type 3 fractures.

Symptoms of an Elbow Fracture

Severe pain is the most characteristic symptom of an elbow fracture. Other symptoms include:

• Inability to move the arm
• Severe pain in the elbow after trauma
• Bruising
• Swelling
• Severe pain when moving the elbow
• Pain when touching the elbow
• Inability to fully extend the elbow
• Numbness in the fingers

Causes of Elbow Fractures

Elbow fractures usually occur due to trauma to the elbow, such as falling on the elbow or receiving a direct blow. The most common causes of elbow fractures include sports injuries and traffic accidents. Falls are also a frequent cause of elbow fractures.

Treatment of Elbow Fractures

Treating elbow fractures can be challenging, primarily due to the fragmentation of the fractures. Fragmented fractures are difficult to restore and may also damage surrounding tissues, complicating treatment.

Cast and Splint Treatment

The main goal in treating all types of elbow fractures is to correctly align the fragments and hold them together until the fracture heals. Immobilization is achieved using slings, splints, or casts.

While splints may not provide as much stability as casts, they have the advantage of being adjustable to accommodate swelling. Orthopedic and trauma specialists determine whether a cast or splint is more appropriate for the specific fracture.

If a cast is used for an elbow fracture, it must be properly fitted to the patient's arm. Initially, patients may feel tightness due to swelling in the elbow. To reduce swelling quickly, the arm should be elevated above heart level, and ice should be applied for 20 minutes every 2 hours. However, care should be taken to avoid wetting the cast during ice application.

Elbow Fracture Surgery

Surgery is another treatment option for elbow fractures, with the surgical approach varying depending on the fracture's condition.

Open Reduction and Internal Fixation

Open reduction and internal fixation involve using pins, screws, and plates to realign and stabilize the fracture fragments. This method is particularly used for humerus fractures. The techniques used in open reduction and internal fixation include:

Osteotomy

In distal humerus fractures, the olecranon bone is cut to provide better visibility of the humerus fracture fragments. The bone and fragments are then fixed in place using pins and screws.

Bone Graft

Bone grafting is used to replace bone fragments that cannot be repaired. It involves using donor bone, bone taken from the patient's own hip, or synthetic materials.

Ulnar Nerve Transposition

In many surgical procedures to treat distal humerus fractures, the ulnar nerve is temporarily moved to protect it during surgery. It is repositioned after the procedure is completed.

Elbow Arthroplasty

Elbow arthroplasty is another surgical option for treating elbow fractures, particularly in cases of severe joint damage. This procedure involves placing plastic or metal implants to maintain elbow joint function.

After removing bone fragments from the elbow, implants are placed in their stead. Additionally, an implant may be inserted into the ulna bone, which acts as a hinge between the two bones, restoring the elbow joint's mobility.

Elbow Arthrodesis

Elbow arthrodesis, preferred for young and active patients, uses screws and plates instead of implants. These devices bring the two bones together and fuse them. In elbow arthrodesis, the elbow joint loses its ability to extend and flex the arm, but the ability to rotate the arm inward and outward is preserved.

Elbow Fracture Exercises

Exercise is recommended as a complement to elbow fracture treatment. No matter how successful the treatment, the joint may lose its range of motion after being immobile for some time, and the muscles may weaken. If not addressed, this can result in patients being unable to use the elbow joint effectively after treatment.

Elbow fracture exercises should be planned by physical therapy and rehabilitation specialists, as each patient's needs vary. The treatment plan should be closely supervised by specialists, and patients should thoroughly learn the exercises they need to perform at home.

Recovery Process for Elbow Fractures

The recovery process for elbow fractures varies depending on the location and severity of the fracture. Recovery can take weeks or even months.

However, for the first 6 weeks after an elbow fracture, patients should avoid heavy lifting and excessive use of the arm. If arthroplasty was performed, these restrictions apply for the patient's entire life. Pain during the first few days or weeks after an elbow fracture is expected, and doctors typically prescribe pain relievers like opioids to manage the pain during this period.