The elbow is the joint that connects the bone of the upper arm with those of the forearm, that is, the humerus with the ulna and the radius. Depending on which bone is fractured, it will be called a distal humerus fracture, a radial head fracture, or an olecranon fracture.
It is usually the result of a fall onto an outstretched arm, although it can also occur from a direct blow with an object or hard surface.
The most frequent symptoms are pain, swelling and functional impairment of the elbow. In distal humerus fractures, the brachial artery may be damaged and joint bleeding may occur; the nerve may also be damaged, causing problems with mobility and sensation in the wrist and hand. When the olecranon is fractured, the ulnar nerve may be injured, causing tingling in the little finger and the outer part of the ring finger.
The diagnosis is clinical, as the history of trauma coincides with the sudden onset of symptoms. It will be confirmed by X-rays of the limb.
Initial treatment must involve controlling pain with painkillers and repositioning the fragments as soon as possible. Treatment will vary depending on the fractured bone and the type of fracture.
Distal humerus fracture usually requires surgery to align the bones. It is important to rule out vascular and/or nerve injury. Surgery is generally open surgery with internal fixation of the fractured bone fragments.
In olecranon fracture, it is usually possible to reposition the fragments with manual manoeuvres, and a long posterior arm splint is left in place. When manual reduction is not possible because the fragments are numerous or very far apart from each other, surgical repair will be necessary.
Radial head fracture can generally be managed with a splint, but sometimes surgery is unavoidable. The arm will be positioned at a 90-degree angle with the forearm and supported by a sling bandage. As soon as pain allows, exercises set out by the doctor are begun to reduce stiffness from immobilisation and increase the resulting degree of mobility following repair of the fractured area.
If the fracture is accompanied by a wound, that is, it is an open fracture, an antibiotic must be given to prevent infection of the fractured area.
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