A number of signs and symptoms point towards a diagnosis of an elbow fracture following an injury to the elbow itself or to any other part of the arm or forearm. Some of the characteristic clinical features include:

• Impaired range of movement of the elbow joint
• Pain and difficulty in moving the elbow joint
• Bony deformity at or around the elbow
• Edema around the site of injury
• Presence of obvious injury such as bruising or redness around the elbow
• Sensation of tightness in the forearm
• Loss of sensation in the upper limb due to injury of the radial, median or ulnar nerve [8]

Examining the range of joint movement can help to determine the type of elbow fracture. A diagnosis of radial head fracture is highly likely to be made when a patient exhibits a loss of ability to rotate the elbow internally and externally. On the other hand, failure of the patient to flex and extend the elbow points towards a supracondylar fracture.

• Weakness

  Injury to the radial nerve will result in weak or absent wrist extension. [nursingcenter.com]

  Signs & Symptoms Treatments Signs and symptoms of an Elbow Fracture may include: Decreased range of motion Visible deformity Pain, stiffness and brusing A pop or snap reported at time of injury Weakness or numbness in the arm, wrist and hand Supports [tria.com]

  An injured nerve may cause weakness, tingling, or numbness in the arm or hand. An injured blood vessel may cause internal bleeding. [nyulangone.org]

  During the healing process, it is important to prevent as much stiffness, weakness, or swelling as possible. [moveforwardpt.com]

  Symptoms of an elbow fracture include pain, bruising, stiffness, swelling in and around the elbow, a popping or cracking sound, numbness or weakness in the arm, wrist and hand, and deformity of the elbow bones. [carrellclinic.com]

• Fever

  Or a fever that lasts for 3 days in a child 2 years or older. [saintlukeskc.org]

  Call the healthcare provider if your child has any of the following: Fever (see “Fever and children” below) Chills Increasing pain Tingling, numbness, or pain around his or her cast or splint Increasing swelling around the injured area Fingers that change [fairview.org]

  NSAIDs, such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. [drugs.com]

• Ecchymosis

  Brachial artery injury should be suspected by the presence of ecchymosis in the anteromedial aspect of the forearm. Comparison of brachial and radial arterial pulses with the unaffected limb is important. [nursingcenter.com]

  Head 4 15 Medial epicondyle 6 17 Trochlea 8 12 Olecranon 10 15 Lateral epicondyle 12 12 (1) +/- one year, varies between boys and girl Classification Presentation Symptoms pain refusal to move the elbow Physical exam inspection gross deformity swelling ecchymosis [orthobullets.com]

• Heart Disease

  Talk with your health care provider before using these medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past. DO NOT take more than the amount recommended on the bottle. [medlineplus.gov]

• Blister

  […] cast or splint Increasing swelling around the injured area Fingers that change color or feel cold Severe itching under a cast (mild itching is normal) A cast that feels too tight or too loose Any drainage comes through or out of the end of the cast Blisters [saintlukeskc.org]

• Arthritis

  Arthritis If a fracture involves a joint (intra-articular), there is a risk of developing post-traumatic arthritis of the joint. [yorkshireshoulder.com]

  Outcomes included grip strength, range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, and a visual analog score for pain as well as radiographic assessment of arthritis, maintenance of reduction, and development of [ncbi.nlm.nih.gov]

  Fractures extending into the joint that are not fixed properly will develop post-traumatic arthritis. [rocmd.com]

  This is to restore the joint lining surface in the hope of preventing arthritis. Sometimes if the fragments are too small to be fixed the triceps tendon can be stitched directly into bone to allow functional use of the elbow. [orthosports.com.au]

  Posttraumatic Arthritis Posttraumatic arthritis is a type of arthritis that develops in a joint after an injury. Even when your bones heal normally, the cartilage lining the joint surfaces can be damaged, leading to pain and stiffness over time. [orthoinfo.aaos.org]

• Elbow Pain

  Three years after trauma, the patient still complained of throbbing and occasional elbow pain. [ncbi.nlm.nih.gov]

  Supracondylar Fracture Lateral Condyle Fracture Other causes of elbow pain... [joint-pain-expert.net]

  Signs and symptoms: The common symptoms of an elbow fracture include Swelling, tenderness, stiffness, and bruising around the elbow joint Restricted movement of the elbow Pain at the elbow joint while stretching Possible damage to nerves and/or artery [orangeorthopaedics.com]

  […] around the elbow joint Restricted movement of the elbow Pain at the elbow joint while stretching Possible damage to nerves and or artery Decreased range of motion Possible numbness in finger, hand or forearm Popping or cracking sound may be felt in the [ypo.education]

• Elbow Swelling

  Additional visual symptoms such as a lump or deformity of the elbow, swelling and discoloration from bruising or redness may be present. [handtoshoulderwisconsin.com]

  Signs and symptoms Impaired range of movement of the elbow joint Pain and difficulty in moving the elbow joint Deformation of the bones around the elbow Swelling around the joint Bruising and redness on the skin around the joint Sensation of tightness [symptoma.com]

  Treatment Process for Elbow Fractures Initial treatment of an elbow fracture often involves applying ice to reduce swelling, pain medication to reduce discomfort, and a splint or sling to immobilize the joint. [oshmanlaw.com]

• Contusion

  ) S50.0 Contusion of elbow S50.1 Contusion of other and unspecified parts of forearm S50.7 Multiple superficial injuries of forearm S50.8 Other superficial injuries of forearm S50.9 Superficial injury of forearm, unspecified Superficial injury of elbow [apps.who.int]

  Anatomy The elbow and forearm form a functional unit whose primary role is to accurately position the hand in space. view Elbow Contusion An elbow contusion results from blunt direct trauma and produces muscle strains and ligament sprains. view Ligament [rocmd.com]

  The exams and tests the healthcare provider may use to diagnose Elbow Fractures in Children include: Physical examination: A thorough physical examination is important in identifying any noticeable deformities, swelling, and contusions, within the elbow [dovemed.com]

  Nerve damage: The three nerves that run through the elbow can be cut, contused, kinked, or pulled in an elbow injury. The resulting nerve damage may be temporary or permanent. Swelling after an elbow injury can press on nerves causing damage. [emedicinehealth.com]

• Joint Deformity

  Signs and symptoms Impaired range of movement of the elbow joint Pain and difficulty in moving the elbow joint Deformation of the bones around the elbow Swelling around the joint Bruising and redness on the skin around the joint Sensation of tightness [symptoma.com]

  Symptoms of elbow fracture include the following pain around the elbow region swelling inability to move the elbow joint deformity around the elbow Movements of the wrist and fingers will continue until there is some injury to the blood vessels and nerves [joint-pain-expert.net]

• Distractibility

  Lateral elbow radiograph demonstrates comminuted (*) fracture of the olecranon with more than 3 mm of distraction of the proximal fracture fragment (double-ended white arrow) by the triceps tendon. This usually requires surgical repair. [emedicine.medscape.com]

  One must be diligent to examine the entire radiograph and not be distracted by only the fracture component of this elbow injury. [nursingcenter.com]

• Seizure

  Bamboozler Answer Posterior shoulder dislocations can occur during seizures because tetanic contraction of the muscles causing internal rotation and posterior displacement is stronger than the opposing muscles. [lifeinthefastlane.com]

The main investigative procedure recommended for elbow fractures is radiography. Diagnosis is made by identifying the fracture in lateral and anterior-posterior radiographs. Radiographs of the normal limb are also taken to compare with the fractured limb. This is particularly important in children because in this age group the presence of growth plates can be mistaken for fractures. Other imaging tests that can be carried out include computed tomography (CT) scanning of the elbow joint [9] or alternatively an elbow joint magnetic resonance imaging (MRI) [10].

Concerns of injury to a blood vessel may provide indication for an arteriogram.

Laboratory blood tests are not indicated unless as part of pre-operative preparation of the patient.

For treatment of elbow fractures, consultation with an orthopedic surgeon is necessary. The goals of treatment and the possible approaches include the following:

• Immobilization via splinting or use of arm slings for un-displaced fractures.
• Proper alignment of the fractured segments in displaced fractures. This demands for surgery where open reduction and internal fixation is carried out to repair the fracture.
• Pain relief by use of analgesics.

Generally, elbow fractures in children heal much better than in adults. However, in both groups the process may be inhibited by a number of complications which can potentially arise as a result of the fracture itself or from the surgical intervention that may be carried out. These complications impact negatively on the prognosis, the common ones being the following:

• Increased risk of bone infection due to direct exposure to the skin in compound fractures [7].
• Injury to adjacent blood vessels especially when the fracture impinges on a large blood vessel.
• Median, radial or ulnar nerve injury due to direct trauma or the limb edema that occurs following injury [8].
• Non-union, where there is failure of the distal and proximal fracture segments in uniting to facilitate healing.
• Mal-union where there is abnormal reduction of the fractured segments.
• Joint stiffness with reduced range of motion (more common in adults).
• Arthritis secondary to the trauma itself which triggers inflammation.
• Implant related complications (infection, mal-position, pain) following surgical interventions with fixation of implants to reduce the fracture.

Elbow injuries highly occur in the set-up of acute trauma which may include [2]:

• Direct blow on or around the elbow joint
• Falling on an outstretched arm or open hand such as by slipping backwards
• High energy impact commonly due to motor vehicle or motorbike accidents
• Transmission of energy to the elbow from a direct injury on the shoulder, the wrist or the hand
• Injury from the side on a flexed elbow such as one protruding outwards from the window of a vehicle.

Sometimes though, elbow fractures develop as a result of limb overuse particularly during sports.

Radial head fractures are the most common elbow fracture in adults.

Owing to the nature of the anatomy around the elbow joint in different age groups, fracture patterns will vary. Among the adults, the most common fracture pattern seen is that involving the radial head while in children supracondylar fractures predominate with an incidence rate of 308 per 100,000 per annum [3].

The most common causes of elbow injury include falling on the outstretched arm or open hand and experiencing a direct blow to the elbow. Apart from the elbow fracture that arises, injury to the neurovascular bundle may also ensue. In supracondylar fractures, the most common nerve injury involves the median nerve while the most common vessel injury affects the brachial artery. Below is a table illustrating the different fracture patterns that occur:

Prevention of elbow fractures lies in averting elbow injuries. Therefore, certain measures have to be put in place especially when engaging in sports activities. It is of utmost importance to protect the elbow by using well fitting pads during sports. Before engaging in intense activity the body ought to be prepared by taking on warm up exercises. It is beneficial as well to maintain body fitness through regular exercise.

The elbow joint is formed by three different bones: the humerus, radius and ulna which form the bony structure of the arm and the forearm. Other structures that comprise the elbow joint include muscles, tendons and ligaments. This joint functions to support flexion, extension and rotational movements.

Elbow fractures arise from injury to either one or more of the three bones that form this joint. The fractures are categorized as intra-articular or extra-articular depending on the site of injury. Intra-articular fractures consist of all fractures that involve the head of radius, proximal ulnar, trochlea and capitellum. On the other hand, extra-articular fractures are those that affect the condyles, epicondyles, supracondylar area and the intercondylar area [1].

Injuries that cause elbow fractures commonly occur in both children and adults thus demanding prompt recognition and management to prevent development of fracture related complications. This is especially important in children who still have active bone growth plates since it will help avert premature arrest of bone development.

An elbow fracture refers to a localized fragmentation of one or more of the bones that form the elbow joint. This joint is formed by three bones: one in the arm (humerus) and two in the forearm (radius and ulnar).

Causes

Elbow fractures almost always occur as a result of injury to the arm or the forearm and sometimes, injury to the hand. The mechanism of injury that leads to formation of the fracture is commonly a direct blow to the elbow or the force generated from falling on the outstretched arm. Instances when these can occur include slipping and falling backwards, being hit on a flexed elbow from the side or a high energy compression during a motor vehicle collision.

Signs and symptoms

• Impaired range of movement of the elbow joint
• Pain and difficulty in moving the elbow joint
• Deformation of the bones around the elbow
• Swelling around the joint
• Bruising and redness on the skin around the joint
• Sensation of tightness in the forearm
• Numbness in the forearm or the hands

Diagnosis

X-rays of the injured limb are used to confirm the presence of an elbow fracture. Other possible imaging tests that can be carried out include a computed tomography (CT) scan or a magnetic resonance imaging (MRI).

Treatment

For simple fractures, immobilization of the joint may be sufficient to allow healing. This is done using splints or arm slings. For more severe fractures surgery may be required in order to re-align the bones and fix them in place using orthopedic implants. Pain relieving drugs are also prescribed.

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