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.

• Pain

  Symptoms include pain and swelling at the front of the elbow. Most fractures are displaced and so require surgical fixation. [sportsinjuryclinic.net]

  The average visual analog score for pain was 2.2 (scale, 0-10). No patients had recurrent elbow instability. Three patients underwent further surgical procedures, all for loss of motion. [ncbi.nlm.nih.gov]

  Pain relieving drugs are also prescribed. [symptoma.com]

• Falling

  Usually, it results from a fall directly onto the joint, or a hard impact. Sometimes it can happen from falling onto an outstretched hand or from a strong muscular force. [sportsinjuryclinic.net]

  Due to a fall on an outstretched hand. Olecranon fractures Due to fall on an outstretched hand or a direct blow force Prevention of elbow fractures lies in averting elbow injuries. [symptoma.com]

  Capitellum fracture Fall on to an outstretched hand, or direct trauma Elbow dislocation Fall on to an extended elbow Common in sport in the young Radial head and neck fractures Mechanism of injury These are most commonly caused by a fall on to an outstretched [patient.info]

• Swelling

  Symptoms include pain and swelling at the front of the elbow. Most fractures are displaced and so require surgical fixation. [sportsinjuryclinic.net]

  Clinical features Patients usually present with swelling, limited range of movement and tenderness over the injured condyle. Crepitus with motion is frequently present. [patient.info]

  Compartment syndrome is a cascade of events that is initiated by soft tissue swelling that impairs blood outflow. [nursingcenter.com]

• Severe Pain

  Acute severe pain in the elbow and forearm Numbness What are the causes? “Twisting” or rotating Elbow Rolled” your Elbow Tripping or falling What are the treatment? Treatment depends on how severe the injury is. [orthopaedics.com.sg]

  It can lead to severe pain in the elbow and numbness in the hand. Fractures are more common in children due to their physical activities as well as their bone properties. [coastlineortho.com]

  It can lead to sudden, severe pain in the elbow and forearm, numbness in the hand and the inability to straighten out the arm. [carrellclinic.com]

• Inflammation

  It is an overuse injury that causes inflammation of the tendons that attach to the bony prominence on the outside of the elbow. [bordercityorthopedics.com]

  Medication may be prescribed for pain and inflammation, such as ibuprofen or even codeine. [rushortho.com]

  Medication Prescription or over-the-counter medications may be given to help reduce inflammation and pain. Medications may include acetaminophen or ibuprofen. Rest and Recovery TOP Healing time varies by age and your overall health. [health.cvs.com]

  Repeating radiographs after inflammation has subsided may be helpful in demonstrating the fracture; this is typically done 7-10 days later. Management depends on the type and degree of angulation 5,7. [radiopaedia.org]

• Ulcer

  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]

• Fracture

  […] with elbow fractures [ 1 ]. [ncbi.nlm.nih.gov]

  The most common elbow fractures include: Radial head fracture Olecranon fracture Supracondylar fracture Fractures coronoid process Intercondylar fractures Condylar fractures Capitellum fractures Fractures of the Coronoid Process The coronoid process is [sportsinjuryclinic.net]

  Lateral condyle fracture The second most common fracture in the pediatric population Trochlea fracture Rarely occurs in isolation unless in combination with other elbow fractures Capitellum fracture Occurs concurrently with posterior elbow dislocations [symptoma.com]

• 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]

• Joint Dislocation

  Elbow dislocation is the second most common large joint dislocation in the adult population. [radiopaedia.org]

  Open fractures, joint dislocation or instability, and evidence of neurovascular injury are indications for emergent referral. [aafp.org]

  When sufficient ligament tearing occurs, and the elbow does not completely dislocate, the elbow experiences signs of instability or slipping out of the joint which includes: A clicking feeling Apprehension or fear of an imminent dislocation A locking [rocmd.com]

  Elbow dislocation Elbow dislocation is the second most common major joint dislocation. [ 5 ] The 'terrible triad of the elbow' refers to a combination of elbow dislocation and radial head and coronoid process fracture - it is notoriously difficult to [patient.info]

• Irritability

  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 minor risk of damage to nerves and blood vessels around the elbow. [orthoinfo.aaos.org]

  Medial Epicondyle Avulsion • 3rd most common elbow fracture in children • adolescent boys • Acute valgus stress (sometimes during armwrestling) • Severe pain over medial aspect, “pop” sound, Ulnar nerve irritation • Elbow dislocations occur in 50% of [slideshare.net]

  Complications include Non-union or inability of the fracture to heal Mal-union or healing of the fracture in a wrong position Loss of elbow movement Nerve injury Infection Irritation caused by plates, screws and wires placed under the skin How long does [joint-pain-expert.net]

  This can cause irritation and pain as the skin is the caught between the hardware and the surface of the table or chair. For this reason, many patients elect to have the hardware removed after the fracture has healed. [mplsortho.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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2. Knapp K. The Elbow. In Hannon, Patrick; Knapp, Kerry. Forensic Biomechanics. Lawyers & Judges. 2006; pp. 243–8. ISBN 978-1-930056-27-5.
3. Houshian S, Mehdi B, Larsen MS. The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures. J Orthop Sci. 2001; 6(4):312-5.
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9. Sormaala MJ, Sormaala A, Mattila VM, et al. MDCT findings after elbow dislocation: a retrospective study of 140 patients. Skeletal Radiol. 2014 Apr; 43(4):507-12.
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