Elbow Fractures | Michigan Medicine

The elbow is a joint between the upper arm and forearm. It is made up of three bones: the humerus in the upper arm, and the ulna and radius in the forearm. A fracture occurs when there is enough force on the elbow to break any of these bones.

The University of Michigan is a leading provider in the treatment of elbow fractures, from simple to complex. Our fellowship trained orthopaedic surgeons specialize in hand, wrist, and elbow surgery. Our goal is to restore mobility and function of the elbow as soon as possible with minimal impact on the patient’s quality of life.

Risk Factors for Elbow Fractures

There are several risk factors that cause elbow fractures:

• Falling onto an outstretched arm, especially from a standing position
• Direct impact to the elbow
• Twisting injury to the arm

Symptoms of Elbow Fractures

An elbow fracture should be evaluated for immediate treatment.

Common signs and symptoms of elbow fractures include:

• Recent trauma to the arm
• Pain, swelling, bruising at or around the elbow
• Limited motion at the elbow

Diagnosis of Elbow Fractures

Whether it takes place in an emergency room or office visit, a physical examination of the affected area is needed to diagnose an elbow fracture.

Additional imaging may also be needed to confirm the presence and extent of the injury:

• X-ray: Images used to determine if fractures are present
• CT Scan: May be needed to get a better detailed image of the fracture fragments

Treatment of Elbow Fractures

Treatment will depend on severity and location of the elbow fracture. Fractures that are out of place or not lined up are more likely to require surgery. Dislocations of the elbow joint, or cartilage surface, need to be put back into place. Fractures that are lined up and unlikely to shift may be treated in a cast, splint, or sling. 

There are multiple factors that help determine the best treatment for elbow fractures:

• Location of fracture
• Age of the patient
• Health of the patient
• Timing of the Fracture

Non-surgical treatment options require immobilization of the elbow for 4-6 weeks:

• Setting of the bone
• Splint/cast/ling
• Limitation of activity

If the fracture is more complex, surgery may be required. Surgical options include:

• Pinning of the elbow
• Fixing the elbow with screws and plates

Hand Therapy and Rehabilitation for Elbow Fractures

Therapy for elbow fractures is provided on site at the University of Michigan’s Hand Program by our team of occupational and physical therapists under the direction of a trained hand therapist. Referrals to local providers can be coordinated closer to home as a more convenient option for patients.

The ultimate goal of therapy and rehabilitation is the restoration and optimization of elbow function, renewed independence and improved overall quality of life. We offer treatment plans that are tailored to fit each patient’s condition, living and work requirements:

• Non-surgical option: For patients who do not require surgery but would benefit from therapy.
• Post-operative rehabilitation: To help patients as they recover from surgical procedures.

Contact Us / Make an Appointment

If you are considering treatment for an elbow fracture, the University of Michigan hand surgeons will guide you, from consultation to recovery, to the best procedures for your individual needs. Our hand surgeons have dual appointments in Orthopaedic and Plastic Surgery with a specialization in Hand. Patients may be seen in the Orthopaedic Clinic for treatment of elbow conditions.

• Orthopaedic Call Center, 734-998-6541

Michigan Medicine Comprehensive Hand Center

Our team of specialists at the Comprehensive Hand Center is dedicated to providing comprehensive care for a variety of hand problems. From arthritis injuries, to congenital hand conditions, to the most complex reconstruction, our hand specialists approach each case individually, with a specific plan designed to maximize the restoration of both form and function. Depending on the types of hand conditions our patients face, our physicians will help determine the best therapies or procedures to maximize hand functionality and normal hand appearances. Visit the Comprehensive Hand Center page to learn more about the program and to contact our hand specialists.

Fractures and Dislocations of the Elbow

A fracture or dislocation of the elbow can be very painful and keep you from your favorite activities. At TriHealth Orthopedics & Sports Institute, our team offers treatment tailored to your injury. Whether you have a simple injury that calls for bracing or a more complex break or dislocation, we’re here for you. Our surgeons, hand therapists and physical therapists work closely together to help you return to the activities you enjoy.

Elbow Fractures and Dislocations

Elbow fractures and dislocations are two different types of injuries to the elbow. A fracture to the elbow is when one of the bones at the elbow joints breaks. An elbow fracture needs to be diagnosed and treated quickly by a medical professional to ensure there isn’t any damage to joint surface of the elbow and to realign the bones so that they can function normally.

An elbow dislocation happens when the bones that make up your elbow joint move out place when compared to the upper arm. This causes the elbow joint to move out of place. This injury requires immediate medical assistance.

Elbow dislocation and fracture causes

While fractures and dislocations are two different injuries, they share similar causes:

• A sudden fall
• Direct blow to the elbow
• Traumatic injuries (like a car crash or fall)
• Athletic injuries

Elbow fractures and dislocations symptoms

It’s important to learn the symptoms of a fractured elbow so that you get care right away. Symptoms include:

• Severe pain
• Swelling at or around the elbow
• Noticeable changes or bumps around the elbow
• Bruising or redness at the elbow
• Difficulty moving your elbow
• Numbness or decreased sensation of your forearm, hand or fingers
• Tight feeling at the elbow or forearm

Symptoms of a dislocated elbow include:

• Severe pain
• Swelling at the elbow
• Inability to bend the arm
• Noticeable movement of the elbow joint

Fractured or dislocated elbow treatment

Your treatment will depend on the type and severity of your elbow injury. The most common treatment for elbow fractures include:

• Functional bracing or splinting – If your elbow is only minimally fractured, then you may need a brace or splint to keep the bones in place while they heal. Most people do not need a cast.
• Surgery – Complex fractures may require surgery to place plates and screws in the broken bones. This helps immobilize the bones as they heal. Serious injuries may need partial or total replacement of the elbow joint to prevent future issues.

Treatment for elbow dislocations may include:

• Bracing – A brace will be used after your joint is reset to allow your elbow to heal while you safely start moving it again.
• Surgery – If you have an unstable elbow, you may need complex surgery to reconstruct the ligaments on the inside or outside of the elbow. TriHealth Orthopedics & Sports Institute is one of the few locations in the region that offers this specialized care.

Hand or physical therapy is a key part of recovering from both an elbow fracture or dislocation. Our therapists offer specialized care and support for individuals with elbow injuries, helping you get back to living everyday life – comfortably and pain free.

Elbow dislocation and fracture risk factors

You may be at higher risk of an elbow fracture or dislocation if you:

• Have osteoporosis
• Participate in high-impact activities
• Were involved in a trauma (like a car accident) or a fall from a height

Elbow dislocation and fracture prevention

It’s impossible to completely prevent an elbow fracture or dislocation. You can, however, take a few steps to lower your risk:

• Wear protective gear during physical activities, like elbow pads when roller skating
• Try not to fall with your arm outstretched
• Don’t try stunts beyond your skill level
• Always have someone helping spot you when climbing a ladder

The care you need – fast

A broken or dislocated elbow calls for emergency medical attention. If you think you’ve seriously injured your elbow, visit one of our urgent care centers. And if you want a second opinion on your injury, our experienced team is here to help. Call us today at 513 246 7846.

Elbow (Olecranon) Fracture | Boston Medical Center

An olecranon (oh-LEK-rah-nun) fracture is a break in the bony “tip” of the elbow. This pointy segment of bone is part of the ulna, one of the three bones that come together to form the elbow joint.

The olecranon is located under the skin of the elbow, without much protection from muscles or other soft tissues. It can break easily if you experience a direct blow to the elbow or fall on an outstretched arm. A fracture can be very painful and make elbow motion difficult or impossible.

Olecranon fractures are fairly common. Although they usually occur on their own, with no other injuries, they can also be part of a more complex elbow injury. In an olecranon fracture, the bone can crack just slightly or break into many pieces. The broken pieces of bone may line up straight or may be far out of place (displaced fracture).

In some cases, the bone breaks in such a way that bone fragments stick out through the skin. This is called an open fracture. Open fractures are particularly serious because, once the skin is broken, infection in both the wound and the bone are more likely to occur. Immediate treatment is required to prevent infection.

What is the anatomy of the elbow?

Your elbow is a joint made up of three bones:

• The humerus (upper arm bone)
• The radius (forearm bone on the thumb side)
• The ulna (forearm bone on the pinky side)

The elbow joint bends and straightens like a hinge. It also helps you to turn your hand palm up (like accepting change from a cashier) or palm down (like typing or playing the piano).

The elbow consists of portions of all three bones:

• The distal humerus is the lower end of the humerus. It forms the upper part of the elbow and makes it possible for your forearm to bend and straighten.
• The radial head is the knobby end of the radius where it meets the elbow. It glides up and down the front of the distal humerus when you bend your arm and rotates around the ulna when you turn your wrist up or down.
• The olecranon is the part of the ulna that “cups” the lower end of the humerus, creating a hinge for elbow movement. The bony “point” of the olecranon can be easily felt beneath the skin because it is covered by just a thin layer of tissue.

The elbow is held together by its bony architecture, as well as ligaments, tendons, and muscles. Three major nerves cross the elbow joint.

What causes olecranon fractures?

Olecranon fractures are most often caused by:

• Falling directly on the elbow
• Receiving a direct blow to the elbow from something hard, like a baseball bat or a dashboard or car door during a vehicle collision.
• Falling on an outstretched arm with the elbow held tightly to brace against the fall. In this situation, the triceps muscle, which attaches to the olecranon, can pull a piece of the bone off of the ulna. Injuries to the ligaments around the elbow may occur with this type of injury, as well.

What are the symptoms of olecranon fractures?

An olecranon fracture usually causes sudden, intense pain and can prevent you from moving your elbow. Other signs and symptoms of a fracture may include:

• Swelling over the “tip” or back of the elbow
• Bruising around the elbow. Sometimes, this bruising travels up the arm towards the shoulder or down the forearm towards the wrist.
• Tenderness to the touch
• Numbness in one or more fingers
• Pain with movement of the elbow or with rotation of the forearm
• A feeling of instability in the joint, as if your elbow is going to “pop out.”

How is a distal humerus fracture diagnosed?

Your doctor will talk with you about your medical history and general health and ask about your symptoms. He or she will then examine your elbow to determine the extent of the injury. During the exam, your doctor will:

• Check your skin for cuts and lacerations. In severe fractures, bone fragments can break through the skin, increasing the risk of infection.
• Feel all around your elbow to determine if there are any other areas of tenderness. This could indicate other broken bones or injuries, such as a dislocated elbow.
• Check your pulse at the wrist to ensure that there is good blood flow to your hand and fingers.
• Check to see that you can move your fingers and wrist, and can feel things with your fingers. In some cases, the ulnar nerve may be injured at the same time the fracture occurs. This can result in weakness and numbness in the ring and small fingers. 

Although you may have pain only at the elbow, your doctor may also examine your shoulder, upper arm, forearm, wrist, and hand to ensure that you do not have any other injuries.

X-ray

This x-ray, taken from the side, shows an olecranon fracture in which the pieces of bone have moved out of place (displaced).

X-rays provide images of your bones. Your doctor will order x-rays of your elbow to help diagnose your fracture. Depending on your symptoms, your doctor may also order x-rays of your upper arm, forearm, shoulder, wrist, and/or hand to make sure that you do not have any other injuries.

How is an olecranon fracture treated without surgery?

While you are in the emergency room, your doctor will apply a splint (like a cast) to your elbow and give you a sling to help keep your elbow in position. Immediate treatment may also include:

• Applying ice to reduce pain and swelling
• Medications to relieve pain

If the pieces of bone are not out of place, a fracture can sometimes be treated with a splint to hold the elbow in place while it heals. During the healing process, your doctor will take frequent x-rays to make sure the bone has not shifted out of place.

Splints are typically worn for 6 weeks before gentle motion is started. If the fracture shifts in position during this time, you may need surgery to put the bones back together.

How is an olecranon fracture treated with surgery?

Surgery is usually required for olecranon fractures in which:

• The bones have moved out of place (displaced fracture)
• Pieces of bone have punctured the skin (open fracture)

Surgery for olecranon fractures typically involves putting the broken pieces of bone back into position and preventing them from moving out of place until they are healed.

Because of the increased risk of infection, open fractures are scheduled for surgery as soon as possible, usually within hours. Patients are given IV antibiotics in the emergency room, and may receive a tetanus shot. During surgery, the cuts from the injury and the surfaces of the broken bone are thoroughly cleaned out. The bone will typically be repaired during the same surgery.

Surgical Procedures

Open reduction and internal fixation.

(Left) A single screw, placed into the center of the bone, may be used to keep the fractured bones together. (Right) Plate(s) and screws may be used to hold the broken bones in place.

This is the procedure most often used to treat olecranon fractures. During the procedure, the bone fragments are first repositioned into their normal alignment. The pieces of bone are then held in place with screws, wires, pins, or metal plates attached to the outside of the bone.

Bone graft.

If some of the bone has been lost through the wound or is crushed, the  fracture may require bone graft to fill the gaps. Bone graft can be taken from a donor (allograft) or from another bone in your own body (autograft)—most often the hip. In some cases, an artificial material can be used.

Removal of the fracture fragment.

If the broken bone fragment is too small to repair, it is sometimes removed. When this is done, the triceps tendon, which is attached to the fragment, is reattached to the remaining portion of the ulna.

What are some possible complications of olecranon surgery?

There are risks associated with all surgery. If your doctor recommends surgery, he or she thinks that the possible benefits outweigh the risks.

Infection. There is a risk of infection with any surgery. Your doctor will take specific measures to help prevent infection.

Hardware irritation. A small percentage of patients may experience irritation from the metal implants used to repair the fracture.

Damage to nerves and blood vessels. There is a low risk of damage to nerves and blood vessels around the elbow.

Nonunion. Sometimes, a fracture does not heal. The fracture may pull apart and the screws, plates, or wires may shift or break. This can occur for a number of reasons, including:

• The patient does not follow directions after surgery.
• The patient has a health problem, such as diabetes, that slows healing. Smoking or using other tobacco products also slows healing.
• If the fracture was associated with a cut in the skin (open fracture), healing is often slower.
• Infections can also slow or prevent healing.

If the fracture does not heal, further surgery may be needed.

What is recovery like after an olecranon fracture?

Pain Management

Most fractures hurt moderately for a few days to a couple of weeks. Many patients find that using ice, elevation (holding their arm up above their heart), and simple, non-prescription medications for pain relief are all that are needed to relieve pain.

If your pain is severe, your doctor may suggest a prescription-strength medication for a few days.

Be aware that, although opioids help relieve pain after surgery, opioid dependency and overdose has become a critical public health issue. For this reason, opioids are typically prescribed for a short period of time. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids.

Rehabilitation

Whether your treatment is surgical or nonsurgical, recovery from a olecranon fracture requires much work.

Without Surgery

Because nonsurgical treatment can sometimes require long periods of splinting or casting, your elbow may become very stiff. For this reason, you may need a longer period of physical therapy.

During rehabilitation, your doctor or a physical therapist will provide you with exercises to help:

• Improve range of motion
• Decrease stiffness
• Strengthen the muscles within the elbow

You will not be allowed to lift, push, or pull anything with your injured arm for a period of time. Your doctor will talk with you about specific restrictions.

With Surgery

Depending on the complexity of the fracture and the stability of the repair, your elbow may be splinted or casted for a period of time after surgery.

• Physical therapy. Most patients will begin exercises to improve elbow and forearm motion shortly after surgery, sometimes as early as the next day. It is extremely important to perform the exercises as often as directed. The exercises will only work if they are done as directed.
• Restrictions. Depending upon the severity of your fracture, your doctor may allow you to use your arm to feed, bath, and dress yourself. However, you may be restricted from lifting, pushing, or pulling activities (including opening or closing doors) with your injured arm for 6 to 12 weeks.
• If you have had an elbow replacement, you will have permanent restrictions on how you can use your arm. For example, you will not be allowed to lift, push, or pull anything that weighs more than 5 pounds with your injured arm for the rest of your life. Before leaving the hospital, it is important to have a clear understanding of the restrictions regarding using your arm.
• Your doctor will also let you know when it is safe for you to drive a car.

Elbow Fractures Overview – StatPearls

Continuing Education Activity

The most common type of fracture in the pediatric population is elbow fractures. Most commonly, individuals fall on their outstretched hand. Prompt assessment and management of elbow fractures are critical, as these fractures carry the risk of neurovascular compromise. Supracondylar fracture is the most common fracture in children under seven years, and these constitute approximately 15% of all pediatric fractures. The peak incidence occurs at around 6 years of age, with a male predominance. However, there are many other variants of elbow fractures. This activity reviews the etiology, presentation, evaluation, and management of various types of elbow fractures, and reviews the role of the interprofessional team in evaluating, diagnosing, and managing the condition.

Objectives:

• Identify the most commonly seen varieties of elbow fractures and describe their particular mechanism and pathophysiology.

• Describe a complete workup and examination for the elbow, when presented with a possible elbow fracture.

• Review the various treatment options for elbow fractures based on the type of fracture.

• Summarize the importance of collaboration and communication among the interprofessional team members to improve outcomes for patients affected by elbow fractures.

Access free multiple choice questions on this topic.

Introduction

The most common type of fracture in the pediatric population is elbow fractures. Most commonly,  individuals fall on their outstretched hand. Prompt assessment and management of elbow fractures are critical, as these fractures carry the risk of neurovascular compromise. The following are the types of elbow fractures in pediatrics:

Supracondylar Fractures

This type of fracture involves the distal humerus just above the elbow. It is the most common type of elbow fracture and accounts for approximately 60% of all elbow fractures. It is considered an injury of the immature skeleton and occurs in young children between 5 to 10 years of age. Based on the mechanism of injury and the displacement of the distal fragment, professionals classify these as either extension or flexion type fractures.[1][2][3]

In an extension type of fracture, which happens more than 95% cases, the elbow displaces posteriorly. The typical mechanism is falling on an outstretched hand with the elbow in full extension. An example is falling from monkey bars. Beware that a nondisplaced fracture may be subtle and may only be recognized by one of the following:

Radiographically, these fractures are classified into three types:

• Type I:  minimal or no displacement

• Type II: displaced fracture, posterior cortex intact

• Type III:  totally displaced fracture, anterior and posterior cortices disrupted 

In a flexion type fracture that happens in less than 5% of cases, the elbow is displaced anteriorly. The typical mechanism is when a direct anterior force is applied against a flexed elbow, which causes anterior displacement of the distal fragment. With the displacement of the fragment, the periosteum tears posteriorly. Since the mechanism is a direct force, flexion type fractures are often open.[4][5][6][7]

• Type I fracture: non-displaced or minimally displaced

• Type II fracture: incomplete fracture; anterior cortex is intact

• Type III fracture: completely displaced; distal fragment migrates proximally and anteriorly

One of the most serious complications is neurovascular injury following the fracture, as the brachial artery and median nerve are located close to the site of fracture and can be easily compromised.

Gartland Classification

Supracondylar fractures can be classified depending on the degree of displacement:

• Gartland Type 1 Fracture: Minimally displaced or occult fracture. The fracture is difficult to see on x-rays. The anterior humeral line still intersects the anterior half of the capitellum. The only visible sign on an x-ray will be a positive fat pad sign.

• Gartland Type 2 Fracture: Fracture that is displaced more posteriorly, but the posterior cortex remains intact.

• Gartland Type 3 Fracture: Completely displaced fracture with cortical disruption. Posteromedial displacement is more common happening in 75% of cases compared to posterolateral displacement which occurs in 25% of cases.

Lateral Condyle Fractures

These types of fracture are the second most common type of elbow fracture in children and account for 15% to 20% of all elbow fractures. This fracture involves the lateral condyle of the distal humerus, which is the outer bony prominence of the elbow.  The peak age for the occurrence of lateral condyle fractures is four to ten years old. Most commonly, these are Salter-Harris type IV ( a fracture that transects the metaphysis, physis, and epiphysis) involving the lateral condyle.

Two types of classifications are used to describe lateral condyle fractures:

Milch classification

• Milch 1: Less common type. Fracture line traverses laterally to the trochlear groove. Elbow is stable.

• Milch II: More common type. Fracture passes through the trochlear groove. Elbow is unstable.

Displacement Classification

• Type 1: Displacement less than 2 mm

• Type 2: more than 2 mm but less than 4 mm displacement. Fragment is close to the humerus

• Type 3: Wide displacement, the articular surface is disrupted.

Medial Epicondyle Fractures

These fractures are the third most common type of elbow fracture in children. It is an extra-articular fracture. It involves fracture of the medial epicondyle apophysis, which is located on the posteromedial aspect of the elbow.  It commonly occurs in early adolescence, between the ages of nine to 14 years of age. It is more common in boys and occurs during athletic activities such as football, baseball, or gymnastics. The common mechanisms of injury are a posterior elbow dislocation and repeated valgus stress. An example is throwing a baseball repeatedly. One term for this is “little league elbow.”

Common presentation is medial elbow pain, tenderness over the medial epicondyle, and valgus instability. 

Radial Head and Neck Fractures

These fractures comprise about 1% to 5% of all pediatric elbow fractures. Most commonly these are Salter-Harris type II fractures that transect the physis and extend into the metaphysis for a short distance. This usually occurs between the ages of nine to ten years.

Olecranon Fractures

Olecranon fractures are uncommon in children. These are mostly associated with radial head and neck fractures.

Etiology

The common mechanism is falling on an outstretched hand, but these can also occur due to a direct blow to the elbow. Elbow injuries most commonly occur in playgrounds, especially while playing on monkey bars.

Epidemiology

Supracondylar fracture is the most common fracture in children under seven years, and these constitute approximately 15% of all pediatric fractures. The peak incidence occurs at around 6 years of age, with a male predominance.

History and Physical

Children commonly present to the emergency room with sharp, intense pain in the elbow and forearm and an inability to extend the arm.

On physical exam, there is obvious deformity of the elbow, swelling around the elbow, and tenderness. Numbness in the forearm or hand is present if there is nerve injury. Pulses should be checked thoroughly to confirm vascular integrity.

Evaluation

Imaging studies include an x-ray with an anteroposterior and lateral view. An x-ray is the best modality to see the type of fracture and whether bones are displaced or not.

Treatment / Management

Management of all elbow fractures is the same, with few differences.[8][9][10]

Supracondylar Fracture

Nondisplaced fractures: Nondisplaced supracondylar fractures do not require operative management. Initial management includes immobilization using a long arm posterior splint while keeping the elbow at 90 degrees of flexion and the forearm in a neutral position.

Initially, it is treated with a splint, which is replaced by a cast as swelling subsides. Follow-up x-ray is necessary after one week to make sure the bone is in place, and the fracture is healing. The cast is usually removed after 3 to 4 weeks.

Displaced Fracture: Displaced fractures require surgical management. The presence of more than 20 degrees of angulation requires orthopedic consultation and reduction under sedation and analgesia.

The following techniques are used:

1. Closed reduction and percutaneous pinning: Displaced bone fragments are repositioned via closed reduction and held by two metal pins placed laterally. Alternatively, three metal pins are utilized if two metal pins are insufficient and there is a severely displaced fracture with free a floating distal segment. It is then covered with a splint or cast to provide stability. Pins are temporary, and both pins and cast are removed after healing has begun in the following few weeks.

2. Open reduction and internal fixation should be performed in the following circumstances:

• Failure of closed reduction

• Vascular insufficiency with a possibility of entrapped brachial artery

• Open fracture

• Consider hospitalization for observation of neurovascular function if there is a displaced fracture or significant soft tissue swelling

Lateral Condyle Fracture

Similar to supracondylar fracture but requires casting for a longer duration (up to six weeks) and close monitoring as there is a tendency for displacement.

Medial Epicondyle Fracture

Treatment of a medial epicondyle fracture is similar to that for supracondylar fracture describe above, with only slightly different technique. Instead of pins, small screws are inserted into the bone to secure the fragments. Therefore, recovery is shorter and requires a splint or cast for a shorter duration (about 1 to 2 weeks).

Radial Head and Neck Fracture

Treatment technique depends on the degree of displacement:

• If less than 30 degrees of displacement of the radial head, immobilization is with a collar without closed reduction.

• If more than 30 degrees of displacement, closed reduction is necessary.

Percutaneous pinning is called for if closed reduction is not successful. A K-wire is inserted to maintain the reduction.

Pearls and Other Issues

Complications

Neuropraxia: This occurs because of nerve injury. It resolves in three to four months. Nerve injury occurs in 11% of supracondylar fractures. Most commonly injured is the interosseous nerve, followed by the radial, median, and ulnar nerves.[11][12]

• The anterior interosseous nerve (arising from the median nerve) and may be involved either due to traction or contusion.

• The radial nerve may be involved with posteromedial displacement

• Median nerve involvement may occur with posterolateral displacement

• Ulnar nerve involvement may occur with a flexion type supracondylar fracture. The ulnar nerve is most commonly involved due to posterior displacement of the proximal fragment.

• Beware that motor testing can only identify anterior interosseous nerve injury. This testing can be done by flexing at the index finger distal interphalangeal and thumb interphalangeal joints and making the “okay” sign. Inability to do so represents a lack of sensory component in the anterior interosseous nerve.

Vascular injury: Brachial artery injury should always be suspected, particularly if the radial pulse is absent. However, the vascular injury may occur even if the hand is pink and well perfused. This may be due to partial transection of a vessel.

Compartment syndrome: this may occur after a supracondylar fracture. Evaluate for the early or impending signs by determining if a radial pulse is absent. This injury results from prolonged ischemia of the forearm. It should be suspected if the following are present:

• Inability to open the hand in children

• Pain on passive extension of the fingers

• Tenderness over the forearm

• Absence of a radial pulse

• A careful neurovascular examination is therefore important to promptly recognize this serious complication.

Malunion: Fracture malunion can lead to cubitus valgus or cubitus varus deformity (common in supracondylar fracture). A common complication is a loss of the carrying angle, which results in a cubitus varus, or “Gunstock,” deformity.

Nonunion: Lateral condylar fractures are more prone to nonunion. These, therefore, require revision surgery.

Enhancing Healthcare Team Outcomes

The management of elbow fractures is with an interprofessional team that includes the emergency department physician, orthopedic surgeon, nurse practitioner, radiologist and physical therapist. It is important to be aware that elbow fractures can be associated with neurovascular compromises. Undisplaced fractures are managed conservatively but all displaced fractures need surgery. Most of the patients need extensive rehabilitation to regain motion and strength. A few patients will have limited range of motion and pain even after full recovery.[13]

Figure

Lateral Elbow Radiograph Elbow Effusion with Occult Fracture. Contributed by Scott Dulebohn, MD

Figure

Rose’s Splint on the left, Splints, Welch’s Splints on the Right, amputation, Fractures, elbow joint. Contributed by Wikimedia Commons, (Public Domain)

Figure

Posterior fat pad sign (supracondylar fracture). Contributed by Wajeeha Saeed, MD

Figure

Elbow fracture (Posterior dislocation). Contributed by Wajeeha Saeed, MD

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Hart ES, Turner A, Albright M, Grottkau BE. Common pediatric elbow fractures. Orthop Nurs. 2011 Jan-Feb;30(1):11-7; quiz 18-9. [PubMed: 21278549]

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Gómez JE. Upper extremity injuries in youth sports. Pediatr Clin North Am. 2002 Jun;49(3):593-626, vi-vii. [PubMed: 12119867]

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Peters P. Orthopedic problems in sport climbing. Wilderness Environ Med. 2001 Summer;12(2):100-10. [PubMed: 11434485]

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Swensen SJ, Tyagi V, Uquillas C, Shakked RJ, Yoon RS, Liporace FA. Maximizing outcomes in the treatment of radial head fractures. J Orthop Traumatol. 2019 Mar 23;20(1):15. [PMC free article: PMC6431334] [PubMed: 30904970]

Elbow Fractures | Houston Fracture Treatment

What is the elbow?

The elbow is a hinge joint comprised of 3 bones – humerus, radius and ulna (see Figure 1). Ligaments hold the bones together to provide stability to the joint. Muscles and tendons originate and insert onto the bones around the elbow to provide force to move the bones and perform activities.

Figure 1: The elbow joint

How do elbow fractures happen?

Elbow fractures may result from falling onto an outstretched arm, a direct impact to the elbow, or a twisting injury. Sprains, strains, or dislocations may occur at the same time as a fracture.

What are the signs and symptoms?

Pain, swelling, bruising, and stiffness in and around the elbow suggest a possible fracture. A snap or pop at the time of injury may be felt or heard. Skin openings may reflect communication between the bone and the outside environment. Visible deformity would indicate displacement of the bones or a dislocation of the elbow joint. It is always important to check for possible nerve and/or artery damage.

How are elbow fractures diagnosed?

X-rays are used to confirm if a fracture is present and if the bones are displaced. Sometimes a CT scan might be necessary to get further detail, especially of the joint surface.

How are they treated?

Stiffness is a major concern after any elbow fracture. Treatment is therefore focused on maximizing early motion. Conservative treatment (sling, cast) is usually used when the bones are at low risk of moving out of place, or when the position of the bones is acceptable. Age is also an important factor when treating elbow fractures. Casts are used frequently in children, as their risk of developing stiffness is small; however, in an adult, elbow stiffness is much more likely. Fractures that are displaced or unstable are more likely to need surgery to realign and stabilize the fragments, or sometimes to remove bone fragments, and ideally allow for early motion. Whenever a fracture is open (skin broken over the fracture), urgent surgery is needed to clean out the tract and bone so as to minimize the risk of a deep infection.

Therapy is often utilized to maximize motion. This might include exercises, scar massage, modalities such as ultrasound, heat, ice, etc., and splints that stretch the joint (static progressive or dynamic splints).

Specific types of elbow fractures:

Radial head and neck fractures (see Figure 2):

Pain is usually worse with forearm rotation. It is critical to detect the presence of a mechanical blockage of motion from displaced fracture fragments. The specific type of treatment depends on the number and size of the fragments. Non-displaced fractures are treated with early motion. Complex fractures often require surgery to repair and stabilize the fragments, or to remove the radial head if the fragmentation is too severe, or occasionally to replace the radial head.

Figure 2:Illustration of radial neck fracture

Olecranon fractures (see Figure 3):

Stable fractures can be initially treated with splint immobilization, followed by gradual motion exercises. Severely displaced or unstable fractures require surgery. The bone fragments are re-aligned and held.

Figure 3: Illustration showing an olecranon fracture, and repair.

Elbow Fractures

What is an Elbow Fracture?

The bones of the elbow joint consist of the humerus of the upper arm and the radius and ulna of the forearm, whose bony articulations fit together like pieces of a puzzle, allowing hinge-like motion in the joint along with pronation and supination of the forearm. The distal humerus, located at the elbow, contains bumps and ridges which are important in the classification of fractures. The lateral and medial epicondyles of the humerus form the bumps palpable on the inner and outer elbow. The protuberance of the capitellum articulates with the head of the radius, and the protuberance of the trochlea articulates with the olecranon of the ulna. The medial and lateral ligaments of the elbow lend support to the joint, along with the muscles and the tendons of the arm.

An elbow fracture occurs when forces applied to the bone are too strong for the bone to tolerate and the bone either bends and cracks, or splits outright into two or more pieces. Elbow fractures in adults are usually classified on whether they are located outside of the joint, called extra-articular, or within the elbow joint, called intra-articular. Extra-articular fractures in adults are almost exclusively all intercondylar fractures. Condylar fractures, epicondylar fractures, and supracondylar fractures occur mostly in the pediatric population and are discussed in Elbow Fractures in Children. Intra-articular fractures in adults include trochlear fractures and capitellum fractures. Radial head fractures and proximal ulnar (olecranon) fractures are also intra-articular and may occur in both adults and children.

What causes an Elbow Fracture?

Intercondylar fractures are caused by a fall onto a flexed elbow. Trochlear fractures rarely occur on their own, they are usually coupled with other types of elbow fracture resulting from major trauma, such as that sustained during a motor vehicle accident. Likewise, capitellum fractures often occur along with radial head fractures, which are a result of a fall on an outstretched arm. Olecranon fractures may occur from a fall on an outstretched arm or from a direct blow to the elbow.

What are the symptoms of an Elbow Fracture?

Elbow fractures are accompanied by sudden onset of pain in the region of the elbow. The arm may appear deformed and be unable to move. If nerve damage is present, numbness may be present. If damage to blood vessels is present, the arm or hand may appear cyanotic and bruising may occur.

How is an Elbow Fracture Diagnosed?

A careful history including the mechanism of injury will establish suspicion for a fracture. Physical exam will reveal a swollen, tender, and often immobile elbow joint. Imaging studies will confirm the diagnosis. Plain films are often followed by more advanced imaging such as MRI or CT scan to determine if nerve and blood vessel damage has occurred and to reveal any occult fractures not visible on X ray.

How is an Elbow Fracture Treated?

Elbow fractures may be treated surgically or non-surgically depending on the classification and severity of the fracture.

Non-Surgical

In general, non-displaced fractures of the elbow can be managed conservatively using splints and slings in the emergency department. Follow up with an orthopedic surgeon is needed, and a cast may be placed once the swelling has dissipated. Physical therapy may be advised.

Surgical

One exception to this rule is the intercondylar fracture. These fractures result in the separation of the lateral medial epicondyle from the medial epicondyle. The fracture is rarely linear, usually a Y- or T- shaped split occurs. This requires open reduction with internal fixation, whether displaced or not.

Displaced fractures of the trochlea, capitellum, and olecranon usually require surgery.

How can Dr. Knight help you with Elbow fractures?

As with any fracture, a break to the elbow can be a traumatic and debilitating injury, but when treated by the skilled hands of an experienced surgeon like Dr. Knight, it is possible to restore your broken elbow to full function.

Dr. Knight is one of the premier hand surgeons in Dallas. We invite you to visit him at our Southlake office or Dallas office today.

Elbow Fractures Fact Sheet

Frequently Asked Questions:

How do you treat elbow fractures?
The severity of the fracture and the type of injury you receive can make a difference in how the injury is treated. If it is a minor fracture, the elbow can be splinted and iced, and immobilized with a splint to let the bone gradually knit back together at its own speed. Pain relief medication can also be used to manage any pain that accompanies the healing process. More severe breaks might involve tendons or displacement of the bone, which can, in turn, necessitate surgical intervention on the part of the doctor. Often, screws and plates are used to hold fractured bone in place if it isn’t a simple fracture that can be easily reset.

Will an elbow fracture heal on its own?
In short, no. Even if a fracture is delicate and a hairline and doesn’t require very much medical intervention, it is still important to splint the injured elbow, at the very least, because if a joint is not properly immobilized then clean healing cannot be guaranteed and the treatment may not be affective.

Are elbow fractures painful?
Elbow fractures can vary, and some involve the nerves of the area, while others do not. Of course, any fracture is going to be painful when it happens, as fractures are by nature the result of some sort of trauma, but the extent of the pain will vary widely from patient to patient and case to case. In some cases, the injury may affect nerves in the elbow which can lead to continued neuropathy as the healing process goes on, and it is important to seek medical help as soon as possible to avoid complications like this in the first place.

How long does an elbow fracture take to heal?
Whether your elbow fracture is treated with conservative methods or surgical intervention, healing time for injuries to the bones of the elbow generally fall somewhere between four to six weeks. The shorter end of the spectrum is more likely for non-displaced fractures with a simple straight line injury, whereas with more complex fractures involving multiple breaks and bone shards or pieces can take longer, due to the complexity of the injury.

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HandAndWristInstitute.com does not offer medical advice. The information presented here is offered for informational purposes only. Read Disclaimer

Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.

Kids Health Information : Fracture care: supracondylar elbow

If your child has a fracture just above their elbow, this is called a supracondylar elbow fracture.

Sometimes, supracondylar elbow fractures can be displaced, which means that the bones are out of alignment. If your child has a displaced fracture, they may need surgery to have pins inserted, which hold the bones in place while the fracture heals. 

An undisplaced fracture means that the bone is still aligned.

For undisplaced and displaced fractures, your child will have a cast and a sling to support and protect the bone while it heals. The cast may be:

• a full cast – this is necessary after surgery
  
• a partial cast held in place with bandages – this is called a backslab.

The cast and sling are placed under loose clothing, and not passed through a sleeve.

This fact sheet provides information on what to do once your child has been treated in hospital for a supracondylar elbow fracture. If you think your child has a fracture and you are looking for first aid advice, see our fact sheet Fractures (broken bones).

Care at home 

Fractures are painful. Although immobilising the arm with the cast and sling will help to reduce the pain, additional pain relief (e.g. paracetamol) is often needed. Give the pain relief medication regularly for the first few days, following the directions on the packet, or as directed by the
doctor.

Elevate the elbow

During the first few days, it is important for your child to rest as much as possible with their elbow and hand elevated on pillows. The hand should be higher than the elbow. This will help to minimise swelling of the elbow, hand and fingers.

Use an arm sling for as long as directed by your child’s doctor, but it can be removed when your child is lying down. Encourage your child to bend and straighten their fingers regularly, and make sure you check their fingers for movement, feeling and circulation.

Skin care

Itching under the cast is common. Make sure your child avoids scratching inside the cast as this may damage the skin and cause infection. Do not let them push any object inside the cast (e.g. don’t allow them to use a ruler to scratch inside the cast). Never cut or attempt to modify
the cast or bandage.

While it may be tempting to remove the backslab for brief periods, it is recommended that you leave it in place.

You can help relieve itch by using a hair-dryer to blow cold air into the cast (do not use warm or hot air as this can burn the skin or warp the cast). Antihistamines may be useful for reducing the itch. Talk to your local pharmacist about a suitable antihistamine medication to use.

Cast care

If your child has a plaster cast, it is important to keep it clean and dry. For showering or bathing, seal the cast in a plastic bag with tape or a rubber band. Never allow your child to immerse the cast in water, even if it is in a plastic bag. For more information, see our fact sheet

Plaster cast care.

Even though fibreglass casts are waterproof, you need to make sure the padding underneath stays dry. If your child has a fibreglass cast, treat it as though it is a plaster cast and avoid getting it wet.

When to see a doctor

Severe pain and swelling, change in the colour of the fingers (white or blue), numbness or pins and needles, and inability to move the fingers are signs that the arm has not been elevated properly (with the hand above the elbow) or that your child’s cast may be too tight.

If any of these signs occur, rest and elevate the arm for 30 minutes. If the swelling or pain improves, make sure that your child is wearing their sling correctly, with the hand higher than the elbow.

After elevating the arm for 30 minutes, take your child to the hospital emergency department immediately if:

• the fingers remain very swollen
• the fingers remain white or blue
• your child complains of pins and needles or numbness in the fingers
• your child is not be able to move their fingers, or complains of pain when you move them
• your child has severe pain that is not relieved by the recommended medication at the recommended dose. 

Take your child to your GP or local hospital if:

• the cast is cracked, soft, loose or tight, or has rough edges that hurt
• you are worried that an object has been pushed inside the cast
• there is a bad smell or ooze coming from the cast
• your child is in increasing pain.

Follow-up

Displaced fractures: Your child will have an X-ray and review by the doctor one week after the injury. The next review will usually be three weeks after the injury. 

If your child had pins placed in the bones, your child’s doctor will explain how and when these are removed. See our fact sheet
Removal of metalware. 

Another follow-up appointment and X-ray will be arranged for six weeks after the injury.

Undisplaced fractures: Your GP can review your child three weeks after the injury, and remove the backslab. An X-ray is not required.

After the cast is removed

When the cast is removed, the skin may be dry and itchy. Bathe with warm water and soap, and apply a gentle, non-perfumed moisturiser.

Your child should begin moving their elbow. Their elbow will usually be stiff for a several months after the cast is removed. Full mobility will return with time, but this may take up to one year. Physiotherapy is not recommended.

Your child should avoid sports and heavy arm use (such as climbing) for one month after removal of the cast. Ask your doctor if you are unsure whether your child is ready to return to sports.

Take your child to your GP if you are concerned about:

• the shape of your child’s arm
• the way they are using their arm. 

Key points to remember

• A supracondylar elbow fracture is a fracture just above the elbow. The fracture may be displaced (where the bones are out of alignment) or undisplaced.
• Displaced fractures may require surgery to put pins in the bones to hold them in place.
• A supracondylar elbow fracture will require cast and sling while the fracture heals. If surgery was required, the cast will be a full cast. If surgery was not required, it will be a backslab (partial cast with bandages).  
• Your child should elevate their arm for the first few days after the injury. The hand should be above the height of the elbow. 
• Ensure your child avoids scratching inside the cast and do not let them push any object inside the cast.
• Seek urgent medical attention if after elevating the arm for 30 minutes your child still shows signs that the cast is too tight.
• Avoid sports and heavy arm use for one month after removal of the backslab.

For more information

Common questions our doctors are asked

Why doesn’t my child need an X-ray at their follow-up
appointment?

If your child has had an undisplaced fracture, there is no need for an X-ray at the follow-up appointment because supracondylar fractures almost always heal by themselves. We always try to minimise X-ray exposure in children when possible.

Do the follow-up appointments need to be at the hospital
where my child was originally treated?

No – you can have your follow-up appointments at a local hospital or medical centre that is equipped to manage fractures. Your doctor will be able to help you find an appropriate place for a follow-up appointment.

Developed by The Royal Children’s Hospital and the Victorian Paediatric Orthopaedic Network. We acknowledge the input of RCH consumers and carers.

Reviewed November 2018.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit
www.rchfoundation.org.au.

90,000 What is an olecranon fracture and how to treat it

Olecranon fracture is a common injury, accounting for approximately 6-30% of all intra-articular fractures. It is more common in young people, but rarely in children. The most common cause is home injury, such as falling and being hit.

Symptoms of fracture of the olecranon:

• Sharp pain in the arm.
• Inability to extend the forearm.
• Swelling and bruising, protrusion of bone fragments.

If treatment is not started on time, trauma can lead to complete immobility of the affected arm.

Which doctor should I contact with an olecranon fracture?

First of all, you need to visit a traumatologist. Your doctor may order a referral to a neurologist depending on your symptoms and X-ray findings. After removing the splint or surgery, you will need to be monitored by a surgeon.

How is the first consultation with a traumatologist going

On the first visit, the doctor asks you about your personal data, how you were injured, whether you visited other doctors – he collects an anamnesis of life and illness. After that, the traumatologist conducts an examination: specifies the localization of pain, sensitivity of the hand.

Diagnosis of fracture of the olecranon

After examination, the doctor will prescribe a referral for X-ray. The study shows the nature of the fracture, therefore, it allows you to choose the optimal method of treatment.In rare cases, with neurological symptoms, the traumatologist prescribes computed tomography.

Methods of treatment of fracture of the olecranon in “Scandinavia”

As part of the conservative treatment of an olecranon fracture, traumatologists use immobilization with a plaster cast, which should be worn for several weeks. After control X-ray, the splint is replaced with a bandage and exercise therapy and massage are prescribed.

Olecranon displacement fractures require surgery.Under anesthesia, a doctor can perform several types of operations, the most common type of surgical aid is osteosynthesis of the olecranon.

Why you should contact the traumatologists of “Scandinavia”

The Scandinavia Clinic is equipped with modern tomographs that allow you to accurately diagnose a fracture and choose the most effective treatment tactics.

• Qualification of doctors . Traumatologists with more than 5 years of experience will make an accurate diagnosis in one visit.
• Loyal terms of admission . We accept nonresident and foreign citizens, you can check with the operator for details.
• Comfortable hospital . The hospital is equipped with modern technology, there is Wi-Fi in the clinic.
• No queues due to normalized patient recording.

Make an appointment with a traumatologist

You can make an appointment with a traumatologist at the Scandinavia clinic by calling our hotline: +7 (812) 600-77-77

symptoms, diagnosis, treatment at the Central Clinical Hospital of the Russian Academy of Sciences

A fracture of the olecranon occurs, as a rule, with a direct fall on the elbow.

There is pain in the elbow joint, aggravated by movement.

Most often, with such fractures, the fragments are displaced. In addition, muscle tendons are attached in this area, which, as it were, “stretch” the fragments to the sides, thereby interfering with the fusion of the fracture. A fracture of the olecranon is an intra-articular fracture, and the earlier the treatment is carried out, the more chances that the function of the joint will recover.

Surgical treatment of fracture of the olecranon

Fractures of the olecranon with displacement are subject to surgical treatment – osteosynthesis (comparison and fixation in the correct position of the fragments).Depending on the severity of the fracture, there are several methods of fixation – with a plate, screws or a wire and a wire (the so-called Weber fixation). If the clips do not cause any inconvenience, there is no need to remove them; if they interfere, you can remove them after a year. Metal detectors on the forearm usually do not respond to metal detectors. The Central Design Bureau of the Russian Academy of Sciences uses titanium plates, steel medical knitting needles, and steel wire. These metals are inert, the body does not react to them, they do not cause allergic reactions and are intended to be found permanently in the body.In our clinic, we use metal structures from leading Western manufacturers in Germany, Switzerland, France, and the USA.

Olecranon fractures heal, on average, in 6-8 weeks. A control X-ray is performed 1 and 2 months after the operation. In case of fractures of the olecranon, it is advisable not only to independently perform the exercises shown by the attending physician, but also to engage with a physical therapy instructor for the speedy restoration of the functions of the elbow joint.

Fixation of the olecranon with a plate

The fragments are placed in the correct position, after which a metal plate is fixed on the bone with the help of special screws, which does not allow the fragments to move.

Fixation of the olecranon with a spoke and wire (according to Weber)

The main advantage of this method is the creation of constant compression – pressure on the fragments, which contributes to faster healing of the fracture.

Fixation of the olecranon with screws

If the displacement is insignificant, this method is most often used – through small punctures in the skin, the olecranon process is fixed with screws.As a rule, a plaster cast is not applied. The stitches are removed after 2 weeks on an outpatient basis. Since the fracture is intra-articular, movements for the development of the elbow joint must be started from the 2nd day after the fixator is installed, but only with those exercises that the doctor showed. This is necessary so that the joint does not stagnate, its stiffness (contracture) does not form, and to restore the maximum range of motion.

A control X-ray is performed 1 month and 2 months after the operation, in some cases more often – as directed by a doctor.

Arthrosis of the elbow joint | Dikul center

Arthrosis of the elbow joint is not very common and, most often, is secondary in nature and is associated with trauma, for example, a fracture of the elbow.
In the event of a traumatic fracture, a violation of the mechanics of the elbow joint is initiated, which triggers the process of progressive degeneration of the elbow joint. Most often, arthrosis of the elbow joint occurs in middle-aged men with a history of elbow fracture.People who use power tools for a long time are also prone to developing arthrosis.

As in all joints, the ends of the bones that form the elbow joint are covered with hyaline cartilage. The hyaline cartilage is very smooth to minimize friction when moving the joint

However, even minor injuries damage the superficial layers of cartilage. Over time, as loads are applied, this worn surface of the cartilage becomes cracked to the point that the bones begin to directly contact each other.With constant excessive load on the elbow joint, changes occur both in the hyaline cartilage and bones, as well as in the soft tissues of the surrounding joint. Deformity of the joint also leads to stretching of the ligamentous apparatus of the elbow joint

Reasons

Arthrosis is caused by the degeneration of the articular cartilage, a process that develops over time. The difference between arthrosis and arthritis is that with arthrosis there is no such inflammatory reaction as with arthritis (for example, rheumatoid arthritis or gout).

Severe strain or fracture can actually damage the articular cartilage. There may also be cartilage contusion when excessive pressure is exerted on the surface of the cartilage.

Elbow osteoarthritis can be idiopathic, that is, without an obvious cause. But, most often, osteoarthritis of the elbow is associated with excessive use of the arm. Initially, the surface of the cartilage does not change, and the effects of the injury may not be visible for up to a month after the injury. But sometimes the damage to the cartilage can be serious.Pieces of cartilage can actually be torn off the bone and these pieces do not grow together. As a rule, such torn pieces are removed with the help of surgery. If the pieces of cartilage are not removed, they move freely within the joint, which can lead to painful manifestations and further damage to the cartilage tissue. The body cannot fully restore the area of ​​cartilage with torn off pieces, and these areas are replaced not by cartilaginous tissue, but by scar tissue.But scar tissue is not as smooth and elastic as hyaline cartilage. Trauma does not have to directly damage the cartilage tissue of the joint for the degeneration process (osteoarthritis) to start. Any damage to the elbow joint can change the mechanics of movement in the joint. For example, after a fracture of the ulna, bone fragments may not consolidate perfectly evenly. And even a small change in the shape of the bones can change the mechanics of movements and lead to the launch of degenerative changes in the joint, since the distribution of load vectors on different parts of the joint changes.Dislocation can also cause long-term mechanical disturbances. After the dislocation, the ligaments are stretched, and the elbow joint can move in a different way. This change in movement changes the vectors of force acting on the articular cartilage. Over the years, this imbalance in articular mechanics can damage the articular cartilage. And since the articular cartilage is not fully restored, the damage to the cartilage increases. And, in the end, pains in the elbow begin to appear.

Arthrosis of the elbow differs from arthrosis of the knee or hip.For an extended period of time, the articular cartilage of the elbow is intact. The joint space remains close to normal. The biggest changes are osteophyte formation and capsular contracture.

Capsular contracture is a process of drying out and compaction of the joint capsule. The capsule consists of two layers: a fibrous coating that surrounds the joint and an inner lining. The inner layer is called the synovium. The synovial layer contains fluid for lubrication inside the joint (synovial fluid).

Symptoms

Elbow pain is the most common symptom of elbow arthrosis and may radiate down to the forearm or up to the shoulder. Often, there may also be a grinding sound accompanying movement in the elbow joint, which is the result of a violation of the smooth surface of the hyaline cartilage. As arthrosis progresses, pieces of cartilage or bone can become lodged in the elbow joint and cause significant restriction of movement (blockage).Because of the small intra-articular space, accumulation of synovial fluid can lead to compression of the ulnar nerve, which can be manifested by sensations of needles in the little finger and ring finger. Patients with arthrosis of the elbow joint often “overdo it” with exertion when playing sports or during work, and in such cases, there is a sharp exacerbation in the joint, where there are degenerative changes. Such an exacerbation can last up to 48 hours and usually manifests itself in stiffness (particularly in the morning) and pain in the affected joint.The exacerbation decreases after rest and the use of NSAIDs (non-steroidal anti-inflammatory drugs) as directed by a doctor. Applying ice can also be helpful. It may take a significant period of time before the next flare-up episode, but, as a rule, each subsequent episode is more intense. The time interval between episodes is shortened and, eventually, the patient will have pain even at rest. As arthrosis progresses, symptoms that are initially triggered by exertion can also be associated with a period of immobility in the future.Thus, if in the early stages of arthrosis rest and unloading of the joint is necessary, in the later stages, prolonged unloading of the joint can only aggravate the problem.

At the later stages of arthrosis, in the presence of persistent pain at rest and at night, as well as with limited joint mobility, it is advisable to consider the issue of surgical intervention. Moreover, at present, arthroscopic operations are used for this. These minimally invasive techniques remove loose bone and cartilage tissue and restore normal elbow function.

Diagnostics

Diagnosis of osteoarthritis of the elbow joint begins with a medical history. The doctor finds out the history of the injury, the relationship of pain in the elbow with daily activities. Since osteoarthritis develops over a long time, the doctor may be interested in events that took place many years ago. For example, some athletes (such as baseball players) have a higher risk of developing osteoarthritis later in life. Men with a history of heavy hand use are also at risk.Also at risk are weightlifters and people doing hard physical labor. The examination allows the doctor to assess the range of motion in the elbow joint, the presence of crepitus during movement, swelling, etc. In addition, the doctor may examine other joints as well. First of all, from objective diagnostic methods, radiography is prescribed, which allows you to determine the presence of a decrease in the joint space and assess the condition of bone tissues, as well as determine the presence of osteophytes. But the state of the cartilage tissue cannot be visualized by radiography, and if such a need arises, then MSCT, CT or MRI is prescribed.MRI allows the most qualitative visualization of both cartilage tissue and other soft tissues (ligaments, tendons, muscles). Laboratory tests are prescribed when it is necessary to exclude inflammatory or systemic diseases (for example, rheumatoid arthritis).

Treatment

Conservative treatment

In almost all cases, doctors first prescribe conservative treatment. The goal of conservative treatment is to reduce pain and maintain sufficient joint function.Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, may be recommended for drug treatment to reduce swelling and pain. Various methods of physiotherapy (electrophoresis, phonophoresis, laser, etc.) are widely prescribed, which also helps to reduce pain. Exercise therapy occupies an important place in the conservative treatment of arthrosis, which allows maintaining the functionality of the joint. In case of severe exacerbation, the use of an orthosis for a certain period of time may be recommended.

In some cases, the patient needs to change or limit physical activity, especially in cases where it is associated with stress on the arm.

Cortisone injections into the elbow joint may provide temporary relief. Cortisone is a powerful anti-inflammatory drug and can be very effective in relieving pain and swelling. The effects of cortisone (or other steroids) are temporary, lasting from weeks to months. There is a small risk of infection with any injection into a joint, and cortisone injections are no exception.In addition, steroids should not be injected frequently as they themselves damage the cartilage tissue.

Surgical treatment

There are several types of operations for the treatment of progressive osteoarthritis of the elbow joint and the choice of technique depends on the severity of joint degeneration, age, level of activity.

Arthroscopic debridement

If the patient has an early stage of osteoarthritis, the physician may recommend arthroscopic debridement.

An arthroscopic procedure uses an astroscope with a tiny television camera inserted into the joint through a small incision.The astroscope allows the surgeon to see the inside of the elbow joint.

During arthroscopic debridement, the surgeon makes other small incisions for the introduction of special instruments, with their help, bone growths (osteophytes) chondromic bodies are removed and the cartilage is resurfaced. Sometimes it is necessary to carry out a capsule release.

The surgeon may also wash the joint. Flushing helps remove tiny pieces of tissue that can irritate the joint. Most patients after debridement report a decrease in pain and an increase in range of motion.

Arthroplasty

Prior to the invention of high-quality artificial joints, surgeons used many techniques to prevent bones from rubbing against each other. For example, a piece of tendon or fascia was placed between the bony surfaces.

Arthrodesis

Joint fixation was quite common before the invention of artificial joints.

Endoprosthetics

Replacement or endoprosthetics of the elbow joint is not used as often as endoprosthetics in the hip joint, knee joint or shoulder, since arthrosis of the elbow joint is much less common than in these joints.In addition, elbow replacement also has a higher complication rate than other joint replacements. Generally, elbow replacement is a good choice for older patients who need improvement in range of motion rather than strength.

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90,000 Bruised and injured elbow – what to do?

Inaccurate movement, a strong blow, an unsuccessful fall – and a sharp pain suddenly pierces the elbow joint, in an instant, rolling over the entire arm, like a high-voltage electric discharge.Doubts are unnecessary here – the elbow injury, as they say, is “evident.” A completely natural question immediately arises: how to act correctly in such a situation, what to do in general and where to start?

Someone will say “go to a traumatologist” – and they will be deeply wrong! Before visiting a traumatologist, the victim needs to be provided with the first pre-medical care, since this is what largely determines the success and effectiveness of the subsequent rehabilitation period.

First aid rules for elbow injuries

Since it is far from always possible to determine the nature of the injury without conducting an examination (with the exception, perhaps, of open fractures), first aid is always general and universal:

1. Stop bleeding, if any.In case of severe bleeding, apply a tight tourniquet above the level of damage, fixing the exact time of its application and temporarily relaxing it every 30-40 minutes to avoid tissue necrosis.
2. Disinfect open wounds (if any) by treating them with any antiseptic: chlorhexidine, hydrogen peroxide, fucorcin, etc.
3. Apply cold to the injury site where there is swelling, redness or blue discoloration of the skin. Important: it is not recommended to apply ice directly to the skin; it is better to put it in a plastic bag and wrap it in a piece of fabric.
4. Immobilize an injured limb. This can be done in two ways: either fix the arm in a bent position at chest level in an impromptu headscarf, or tie the arm to the body.

What not to do in case of elbow injury

Prior to the examination and clarification of the nature of the injury, it is prohibited to take the following actions:

1. Try to correct the alleged dislocation yourself. This can only be done by a specialist who has a good understanding of the anatomy of the elbow joint.
2. Forcefully feel the elbow for bone fragments. Such a “self-diagnosis” will not bring any intelligible result, but you can easily displace a broken bone.
3. Lubricate the injury site with warming ointments. Such funds cause increased blood flow, which in the first few days after injury can only do harm.
4. Postpone the visit to the doctor, reassuring yourself that “it will hurt and go away.”

General principles of treatment

After the first aid has been provided, the victim is taken to the trauma center, where the necessary diagnostic measures are taken, according to the results of which the most optimal therapy, depending on the nature of the injury, is prescribed:

1. Contusion . As a rule, the patient is advised to minimize physical activity on the limb, and to accelerate the resorption of hematomas, use warming ointments or attend physiotherapy procedures.
2. Tendon injury . With a complete rupture, the treatment is only surgical. In case of partial damage, prolonged immobilization is recommended – from 6 weeks.
3. Dislocation . If the features of the injury do not require surgical intervention, then the joint is adjusted, after which the patient is advised to limit motor activity with the injured hand and anti-edema therapy is prescribed.
4. Fracture .Similar to the dislocation of the elbow, if surgery is not required, the victim is prescribed a prolonged (from 30 days) immobilization, with decongestant therapy if necessary.

The role of braces in the treatment of elbow injuries

Since any elbow injury, regardless of its severity, presupposes a certain period of complete immobilization or limitation of joint mobility, high-quality fixation of the joint is considered as the main condition for complete recovery as soon as possible.To achieve this goal, modern traumatology uses two main types of products: a bandage and an orthosis.

Bandage

A product of semi-rigid or soft design, used mainly to control swelling in case of bruises of the elbow, as well as to stabilize the joint in the anatomically correct position in case of mild forms of dislocation or in the later stages of rehabilitation after fractures or surgical operations.

The main action of the bandages is compression and fixation, partially reducing the load on the joint tissues.

Orthosis

A product of rigid or semi-rigid construction, intended for partial or complete immobilization of the elbow joint in a functionally correct position. Used for simple fractures, complex dislocations or tendon injuries.

A special type of orthoses is a hyperextension orthosis – a product whose design allows limiting the mobility of the elbow joint within strictly specified limits. This allows you to correct the increase in the load during the rehabilitation process after especially severe injuries.

How to Speed ​​Up Full Recovery

This question worries injured patients most of all – is it possible to accelerate the moment of full recovery of the elbow’s working capacity?

Modern medicine has not yet learned to work miracles, and therefore the only way to quickly recover from an elbow injury is to strictly adhere to the mode of restriction of mobility, fulfill all the doctor’s prescriptions, as well as perseverance during the period of joint rehabilitation (exercise therapy).

If you follow these recommendations, the “miracle” of recovery will not be long in coming, and the elbow will soon return to its previous mobility, as if there was no injury at all.

Consultant of the netran.ru online store

Volodkov Alexey Viktorovich

What is forearm dislocation? Causes and treatment

Instability and dislocation are the most common injuries of the elbow joint.

What is a dislocation of the forearm

The most common elbow joint injury is a dislocated forearm.After a dislocation, the elbow joint is often unstable. ¹

At the moment of dislocation, the ligaments that stabilize the elbow joint are torn. Sometimes the joint capsule and muscles also rupture. The severity of the dislocation is determined by the displacement of the bones relative to each other. The greater the displacement, the more pronounced damage to the ligamentous apparatus has occurred.

The figure shows the right elbow joint, side view.The figure shows the ligamentous apparatus, which is damaged in case of dislocation.

In some cases, dislocation is accompanied by a fracture of the bone or bones that form the elbow joint. This condition is called fracture dislocation.

Instability of the elbow joint

Instability means that the ligamentous apparatus is no longer able to maintain bone mobility within the physiological norm.Obviously, this negatively affects the ability to work. The instability causes pain and damage to the articular cartilage, which can lead to the premature development of arthrosis.

Causes of dislocations and instability

Dislocation of the forearm is caused by accidents in which the elbow joint is under excessive stress. The instability is usually the result of damage to the ligaments.It usually occurs acutely – after a dislocation or fracture. Almost every third dislocation of the forearm is the cause of the subsequent instability of the elbow joint. Instability can also result from elbow surgery.

Symptoms and Signs: Pain and Swelling

In case of dislocation, the joint takes on an unnatural configuration, and its mobility is sharply limited. Then there is a pronounced edema.The attempt to move is accompanied by severe pain. Often the pain also spreads to adjacent segments of the limb. Numbness and sensory impairment below the level of the elbow can occur as a result of nutritional or nerve damage.

Risk Factors:

Avoid Frequent Overload

Frequent repetitive loads and / or overloads, for example, when playing sports, can lead to chronic injury to the ligaments, which ultimately leads to instability of the elbow joint.

Prevention of injuries of the elbow joint

Prevention of damage to the elbow joint is difficult, because it is almost impossible to predict an accidental injury. People with congenital instability of the elbow joint or with habitual dislocation (a dislocation that occurs during normal movement without excessive force) should follow an orthopedic regime aimed at reducing the likelihood of dislocation, including the use of orthoses.

Treatment of forearm dislocation and elbow instability

Contracture (permanent limitation of mobility) of the elbow joint develops rather quickly compared to other large joints. Therefore, early mobilization after a dislocated forearm is critical to maintaining elbow mobility. In this case, constant supervision by a doctor is very important.

Treatment of dislocations

Treatment of dislocations: reduction and rehabilitation

The first step in the treatment of dislocation of the forearm is reduction. It is carried out in a hospital or trauma center after an X-ray examination and with proper pain relief.

Magnetic resonance imaging (MRI) will be performed to clarify the nature of the ligament injuries.For complex fracture dislocations, computed tomography (CT) may be required to clarify the nature of the injury.

Minor ligament injuries can be treated conservatively, often with orthoses to maintain an optimal orthopedic regimen.

In case of massive injuries, surgical treatment may be required. During surgery, the ligaments are sutured or replaced with donor tendons.

Treatment of instability

Elbow joint instability treatment

With a slight instability, the basis of treatment is physiotherapy exercises.In severe cases, surgical stabilization of the joint is required. Subsequently, the patient must also train the muscles and observe the orthopedic regime.

medi products for the treatment of the elbow joint

To stabilize the elbow joint during conservative treatment and postoperative rehabilitation, medi manufactures several products.

Source

¹ Ref.https://medlexi.de/Ellenbogenverrenkung_(Ellenbogenluxation)

Human body

Human joints differ in shape

Joints

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Traumatologists of Moscow – latest reviews

After manual procedures with Dr. Mitin, I can safely say goodbye to my sciatica! I could not even imagine that you can get rid of him without resorting to a bunch of pills and ointments! The doctor is just fabulous! The treatment helped a lot, and I am happy to tell my friends about the doctor! Discreet and charismatic, polite and professionally erudite specialist

Olga,

November 18, 2021

Came with a child.At the reception they talked about their problem. The doctor consulted us, wrote out our further actions, what to do next, how to be treated. Alexey Mikhailovich communicated well with the child. A pleasant impression remains. My son also shared with me his positive impressions of the doctor.

Helena,

November 16, 2021

Dr. Akashev seemed very knowledgeable.He tries to find ways to help the patient as much as possible, paying attention to the symptoms and complaints, evaluating them together. I liked his welcome and participation very much. Everything was so delicate and thorough that there are simply no words! Ruslan Vladimirovich was recommended to me. I am grateful for the tip, the treatment was exhaustive.

Yana,

12 November 2021

In general, Georgy Levanovich is friendly and professional.The only thing that upset me was that there were no recommendations and prescribed physiotherapy from the doctor. At the appointment, the doctor just did an examination and said to develop a brush.

Alexander,

October 31, 2021

The reception went well.The doctor received me, explained everything, examined and consulted. We have not yet made a final decision and agreed to call in a couple of days. The doctor promised to consult with other specialists and give me information on further treatment. It is evident that he is an attentive and adequate specialist. I turned to him on the advice of my acquaintances. I was told that he is a strong doctor and will definitely help me. I thank him for paying attention to the problem, and not statistically treating the complaints.

Alexander,

October 28, 2021

We called Farkhod Bakhromovich at home.The doctor did an ultrasound scan and a blockade. He told and showed us everything. Also, the doctor issued appointments and treatment. There was enough time for assessment and assistance in our problem. We were completely satisfied with the reception and the doctor! We will recommend a specialist to friends and acquaintances!

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October 15, 2021

I didn’t really like the reception.The doctor, of course, told me to raise my hands to the side or up, but did not perform any palpation. The doctor very often referred to the Internet. I even asked if I could come for a follow-up appointment in a month, but I said no. It seemed to me that a strange specialist. As a doctor, I sat for a very long time and thought before prescribing something to me. Therefore, I will not apply again. Calm and polite specialist. But about my professional qualities, a doubt crept in.

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12 October 2021

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October 10, 2021

After undergoing treatment with the doctor, I was pleased with the result.I thank him for the available consultations during which answers to all my questions and explanations of the causes of the disease were received. An attentive doctor, prescribed a treatment for which I had no contraindications. In addition to everything, Dmitry Valerievich is also a positive person. If anyone asks I will definitely recommend it. Thanks.

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November 19, 2021

I really like Vasily Viktorovich as a doctor.