Elbow fractures

Photo of elbow anatomy at

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By Sue Reive

Elbow fractures are quite common, especially in children. They account for 10 per cent of all childhood fractures, most likely because kids are active, riding bikes, running, jumping and sometimes falling.

In the elbow, the bone is superficial with minimal soft tissue covering. A fall on an outstretched arm, landing directly on the pointy tip of the elbow, or a direct blow to the elbow are the usual causes of fractures.

The elbow joint consists of three bones joined together by a capsule: the humerus (arm bone) articulates with the radius and ulna (forearm bones). The elbow joint is considered a three joint complex: the joint between the rounded humerus (trochlea) and the concave ulna (trochlear fossa), the joint between the rounded humerus (capitulum) and the concave radial head and the joint between the radius and ulna. Note that the ulna has a hook-like appearance at the joint due to the olecranon, the bony tip of your elbow. Thus, the elbow joint is classified as a hinge joint where bending and straightening occur. The joint between the radius and ulna is classified as a pivot joint as the radius spins around the ulna, allowing the forearm to turn the palm up and down.

All three joints share the same soft tissue capsule which holds the bones together and is reinforced by ligaments. There are also nerves on either side of the elbow; the ulnar nerve, on the inside of the elbow, is often referred to as the funny bone.

There are three types of fractures of the elbow: radial head and neck fractures; distal humerus fractures; and olecranon fractures. I will focus on olecranon fractures which are common due to the bony appearance and lack of protective soft tissue covering. Symptoms include pain, swelling, bruising and a limitation of movement, particularly in straightening the elbow. There can sometimes be numbness if the closely associated nerves are compressed.

Doctors will examine the patient and ensure the integrity of the nerves and blood vessels. X-rays usually confirm the diagnosis. Treatment depends upon the severity of the fracture. If the fracture is not displaced, it is possible that the arm can be splinted in a half-cast while using a sling for six weeks to allow sufficient boney healing. Unfortunately, most olecranon fractures displace, moving out of position, which requires surgery to put the boney pieces back into alignment. This is usually done with a metal plate and screws or wires and is referred to as OIRF (Open Reduction Internal Fixation). Occasionally a bone graft may be necessary. An open fracture is the most severe, where the bone breaks and protrudes through the skin – that requires immediate surgery.

Post-operative treatment includes two weeks of immobilization of the elbow in a half-cast with a sling. It is very important to frequently move the hand and fingers to maintain circulation to prevent blood clots. To reduce swelling, the hand must be elevated one foot above the heart. Applying ice packs will also help.

After two weeks, provided sufficient healing is seen on an Xray, patients will be able to start moving their elbow but not bear weight on it. It is crucial to mobilize the elbow joint as soon as possible because it tends to stiffen up and the patient could be left with a slight reduction in range. It is difficult because there are three joints in the elbow that need to work together to allow movement. Strengthening exercises start as early as six weeks or as late as 12 weeks – it depends on whether the bones have knit together sufficiently to allow loading. It can take three to four months for a fracture to completely heal.

I am quite familiar with an olecranon fracture. Last October 26, I fell off my bicycle and fractured the olecranon off my ulna. I guess I’m just a big kid at heart! It was displaced and required surgery (ORIF). I have a plate and seven screws. In fact, the two X-ray pictures in this article are my elbow. Luckily, I received great care at the Ottawa Hospital, and I was able to return to work six weeks after surgery. While I still plan to cycle in the Gatineau hills, I will no longer be flying down the Pink Lake hill like I used to!

Sue Reive is a physiotherapist at Ottawa Physiotherapy and Sport Clinics Glebe.