Elbow fractures occur when an injury leads a to loss of the bone integrity around the hinge joint formed by the radius, ulnar and humerus.
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:
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.
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  or alternatively an elbow joint magnetic resonance imaging (MRI) .
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:
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:
Elbow injuries highly occur in the set-up of acute trauma which may include :
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 .
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:
|Fracture pattern||Occurrence||Unique complications||Cause of fracture|
|Intercondylar fractures||More common in adults than in children||Separation of the condylar fragments.|
|Supracondylar fractures||The most common fracture in children consisting of 60% of all fractures. Rare beyond the age of fifteen . 95% of supracondylar fractures are the extension type and the remaining 5% are flexion type.||Commonly causes injuries to the median nerve, radial nerve and anterior interosseous nerve.||Extension type occurs due to an extension force that also causes posterior displacement while flexion type occurs from flexion force that causes anterior displacement.|
|Medial epicondyle fracture||More common in children||Due to avulsion injury following elbow dislocation posteriorly or out of the impact of a direct blow.|
|Lateral epicondyle fracture||Uncommon in all age groups||Due to avulsion injury. Its appearance on a radiograph may resemble the radiolucency of the epiphysis .|
|Medial condyle fracture||Occurs in children, although rarely.||Results from a fall on the outstretched hand or the shear impact from extreme valgus deformity.|
|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 or fractures of the radial head; rarely in isolation||Results from a fall on the outstretched hand.|
|Radial head fractures||The most common elbow fracture especially in adults||Related injuries are very common.||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. 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 .
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).
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
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).
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.