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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. (hyperlink once article is posted) 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 through the use of 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.


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