Fracture

What is it?

This involves a break in one or more of the three bones that make up the elbow joint; the upper arm (humerus), radius or ulna (forearm bones). 

 

Why does it occur?

Falling onto an outstretched arm or direct blow to the elbow upon reaching the ground are usually the most common mechanisms in older patients. Although contact sports and road traffic accidents are also sufficient to cause these fractures in younger patients. A lesser impact causes injury in older patients due to its weakened osteoporotic nature.
What are the symptoms?

Severe pain, swelling and difficulty in moving the arm. A deformity may be evident (site dependent on which bone is affected) with surrounding bruising and a grinding sensation when attempts are made to move the limb.

How is it diagnosed?

In addition to taking a history and examination, your clinician will take radiographs of the shoulder to determine diagnosis. Occasionally a CT or MRI will be needed for a more detailed view of the fracture pattern and level of displacement in order to plan management.

How is it treated?

Distal humerus

1. Non-surgical treatment

This can be considered where the bones are still in good alignment and considered unlikely to move (stable). The arm is supported in a sling for comfort, but to avoid stiffness early bending and straightening of the elbow should be encouraged as soon as pain allows. Some patients find they can’t completely straighten their elbow after injury which is sadly unavoidable. Further loss of range of movement is prevented by regular flexion and extension of the joint. Repeat x-rays are taken at 2 weeks to clarify if the fracture is stable or if the bones have moved and surgery is now needed.
Conservative management may be considered as definitive treatment in some elderly patients where an operation would be heavy handed. This includes those who may be cared for by others and had limited use of their arm prior to injury. Therefore surgery to improve the function of their elbow wouldn’t be in their best interests. The sling may be used for 4-6 weeks and early movement encouraged. As the fracture site scars up at 6-8 weeks it will become less painful.

2. Surgical treatment

The main indication for operation includes fractures involving the joint surface and those that are particularly displaced or unstable. Any damage affecting the smooth articulate surface of the joint will cause uneven wear over time and pain.

Decision to operate will also depend on the characteristics of the patient, including their bone health, comorbidities and activity levels. Surgical options include fixing the fracture with a plate and screws, or in some cases a half or total joint replacement is warranted.

Olecranon (Ulna) - Some of these fractures can be managed non-operatively in a sling as above for distal humerus fractures. This will be dependent on the patient and fracture pattern with early movement encouraged. Where surgery is considered, the bones may be fixed using wires or a plate and screws.
Radial Head - The majority of radial head fractures are managed without an operation and a short period in a sling for comfort. But for those who have more complex fracture patterns an operation may be needed to fix, remove or replace the radial head.