Elbow fracture, surgery and rehabilitation exercises

What is an elbow fracture?

An elbow fracture is the rupture or injury to at least one of the bones that form the joint between the humerus (upper arm), ulna, and spoke (elbow).

The elbow joint plays an important role in lifting weights, dressing, washing, combing and working.

Assessment of the elbow and diagnosis
© Massimo Defilippo

Possible injuries can occur on the humerus, the radial head and the epicondyle as well as intercondylar or supracondylar.
Fractures of the olecranon (upper edge of the ulna) account for about 10% of the elbow injuries and mainly affect adults. The ulnar nerve can be injured.
In general, fractures of the radial head are caused by a fall on the stretched arms, i.e. indirect trauma.
Supracondylar fractures cause lateral displacement of the distal epiphysis of the humerus, often affect children due to direct trauma, and are dangerous due to possible radial nerve injury.
Injuries to the humerus are rather rare.

Falling elderly is much more likely to cause a wrist fracture, which is why an elbow fracture is less common in people over 65 years of age.
Usually it occurs on one side either on the right or on the left.
In severe cases, in addition to fracture, luxation can also occur, for example a Monteggia fracture consists of a fracture of the ulna and a luxation of the spoke.

What are the causes of the elbow fracture?

elbow fracture
© Massimo Defilippo

X-ray of a broken elbow, showing that the spoke epiphysis is slightly torn.
Elbow fractures are caused by direct or indirect trauma with an angled elbow.
They occur in motorcycle accidents and bicycle falls with the elbow bent and supinated, or in a severe impact, such as a fall from the first floor.
Slipping backwards (for example on a snowboard) is more likely to cause an elbow fracture.

How are elbow fractures classified??

Elbow injuries can occur supra-condylarly, intercondylarly or on the radial head. It depends on whether they happen above the humerus, in between, or on the spoke.
According to the Mayo Clinic, radial head fractures on the elbow can be divided as follows:

  • Type I: not postponed or with a diastasis (removal) of the fractures of less than 2 millimeters, the healing prognosis is good.
  • Type II: with or without debris, makes up 80-90% of the elbow fractures, the healing prognosis is pretty good.
  • Type III: shifted and unstable, here too there may or may not be a debris fracture, usually occurs in connection with an injury to the head of the spoke.
    They are very rare and make up around 5% of fractures. The recovery times are extended and the healing prognosis is reluctant.

What are the symptoms of an elbow fracture?

The patient comes to the emergency room with severe elbow pain and swelling of the injured area with a visible hematoma.
Moving the arm is almost impossible due to the pain, the functionality is therefore almost completely limited.
If the fracture is displaced, a depression above the olecranon can be seen with an elbow bent at 90 °.
If the injury is severe, the ulnar nerve (elbow nerve) may also be injured. The result is a series of symptoms on the ulnar side of the wrist, in the little finger and in the ring finger.

Which diagnostic exam is best for an elbow fracture?

X-ray showing the insertion of a plate on the broken forearm.
© Massimo Defilippo

The most suitable examination for fractures is the X-ray. For the elbow joint, the elbow must be bent at a right angle and the image taken from the side.
When the elbow is stretched out, one cannot see whether the fracture is displaced and whether the fragments fit together.

Diagnosis of the elbow fracture

The doctor will review your medical history, the way the trauma occurred, and the Signs and symptoms of the patient; if he suspects a broken bone, he orders an x-ray and leads clinical trials through.
When examining the patient, some deformations can be identified, which indicate a displaced fracture. Indeed, in the case of an olecranon fracture, the triceps tendon pulls the bone fragment towards the shoulder and thus causes a clearly visible deformity of the elbow.
The most suitable test is the extension of the elbow. If the patient does not succeed, there is a 50-60% chance of a fracture.
If the patient can fully extend the joint, an X-ray can be dispensed with. However, the patient should continue to be followed up the week after the accident because if the pain persists there may be a minor injury.
Magnetic resonance imaging is rarely performed. This examination has the advantage that it also shows a microfracture. However, this type of fracture heals spontaneously over the course of around 2 weeks.

Which therapy is suitable for an elbow fracture?

Fractures that have not been moved are treated by fixation with a plaster cast or an orthosis for a period of around 30 days. If the subsequent X-ray check does not show any callus formation yet, the bandage must be worn for another month.
Children may wear plaster casts for a maximum of 15 days.
If the fracture of the humeral head is displaced, the broken fragment moves in the direction of the hand; The orthopedic surgeon must decide whether to remove the fragment or to fix it with the spoke using a metal nail.
If the displaced fracture is epitrochlear or occurs at the level of the epicondyle, the fragment moves significantly. Then the break must be repositioned and fixed with a metal nail.

An olecranon fracture is also treated with surgery, since the triceps tendon often keeps the fracture displaced and thus prevents consolidation. In this case, a Kirschner wire edging is used to hold the fragments in place. Then the whole thing is fixed with a metal plate.
Kirschner wires are not simple fiber threads, but small metal wires made of stainless steel, which are bent with the pliers.
The bezel serves to counteract the forces that tend to pull apart the bone fragments so as to compress the fragments together.
If it is a broken wreck that cannot be repaired with surgery, the surgeon can insert a bone graft from the tissue of the fibula.

There are often side effects (medium to long-term consequences) of the fracture. Often the mobility of the elbow cannot be restored 100%. The radial or ulnar nerve can also be injured.
If the patient experiences severe pain, the doctor can also prescribe medications such as nonsteroidal anti-inflammatories. However, it is better to use analgesics because inflammation is a body reaction that favors the elbow reconstruction and should therefore not be hindered.

Three-dimensional CT that shows the results of an elbow fracture with osteosclerosis and bone deformation.
© Massimo Defilippo

Complications from an elbow fracture

  • Rigidity. Diffraction and extension are only possible to a limited extent in the event of a shifted and multiple fracture.
  • Arthrosis. Degeneration of the cartilage and joint can cause pain and chronic inflammation.
  • Chronic instability. The elbow is not stable and can dislocate.
  • Pseudarthrosis or poor growth. The fragments do not grow together or in an unnatural position. This complication is particularly evident when the fracture has not been treated. If the fracture has not healed after a few months, you can work with shock waves that stimulate reconstruction.
  • Infection, especially with open fractures.
  • Injuries to arteries and nerves, especially the ulnar nerve, which can be pinched by fibrous post-traumatic scar tissue. Symptoms include elbow pain up to the fingers, tingling, loss of strength and sensitivity from the elbow to the small one finger and the ring finger.

Which rehabilitation takes place after an elbow fracture?

Elbow fractures need to be treated as soon as possible to regain mobility. The hardest part is getting full flexion and extension back.

The first part of physiotherapy is the use of magnetic therapy to promote the formation of callus in the bone. It can also be performed on operated patients and even when a plaster cast is applied.
As soon as possible you should start with passive rehabilitation and assisted passive rehabilitation exercises in order to recover as well and quickly as possible.
To accelerate healing, you have to work hard both passively and actively.
As soon as the pain allows, you should start building muscle.

Three-dimensional CT that shows an elbow fracture with bone deformation.
© Massimo Defilippo

How long does it take to heal? forecast

The recovery times depend on:

  • the severity of the break,
  • complications,
  • the age of the patient,
  • other diseases from which the patient suffers.

If the fracture is not postponed, a young person can fully recover within 2-3 months, while it often takes 3-4 months for an older person.
If it is a complicated fracture with many fragments, it will take more than 6 months to heal completely, but the patient will no longer be able to fully flex and extend the joint.
The full range of motion is rarely necessary in daily life. Therefore, patients can usually live as before and also lift weights.


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Christina Cherry
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