ELBOW FRACTURES

Three bones, the humerus, radius and ulna, make up the elbow joint. Elbow fractures may occur from trauma, resulting from various reasons; some of them being a fall on an outstretched arm, a direct blow to the elbow, or an abnormal twist to the joint beyond its functional limit. The types of elbow fractures include:

  • Radial head and neck fractures: Fractures in the head portion of the radius bone are referred to as radial head and neck fractures.
  • Olecranon fractures: These are the most common elbow fractures, occurring at the bony prominence of the ulna.
  • Distal humerus fractures: These fractures are common in children and elderly people at the lower end of the arm bone. Nerves and arteries in the joint may sometimes be injured in these fractures.

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.

To diagnose an elbow fracture X-rays of the joint are taken. In some cases, a CT scan may be needed to view the details of the joint surface.

The aim of treatment is to maximise early motion and to reduce the risk of stiffness. Non-surgical treatment options include pain medication, ice application, the use of a splint or a sling to immobilise the elbow during the healing process and physiotherapy. Surgery is indicated in displaced and open fractures to realign the bones and stabilise the joint with screws, plates, pins and wires. Most fractures of the lower end of the arm bone need at least 1 if not 2 plates placed either parallel or perpendicular to each other.

Some fractures of the lower end of the arm bone (distal humerus fractures) which are in multiple pieces and not reconstructable in the elderly with brittle bones, may require either a partial elbow replacement or a total elbow replacement. After fixation of complex lower end of arm bone fractures Dr Bala prefers to place the ulnar nerve in the front (ulnar nerve transposition) of the elbow to prevent irritation of the nerve from the plates, screws and scar tissue. 

Fractures of the socket of the elbow joint (olecranon) are usually treated with wires, cables, screws or plates.

 

Fractures of the front of the socket of the elbow joint are called coronoid fractures. Depending on the size of these fractures and if they cause instability of the elbow joint, these may be fixed either with suture fixed outside the bone with a metal button (endobutton), headless titanium screws or special anatomic plates.

Fractures of the ball of the ball and socket joint of the elbow are called capitellum fractures. These are often fixed with headless screws.

The treatment of radial head fractures is explained more in detail in a section dedicated to this condition. Often high velocity injuries of the elbow are associated with 2 or more fractures and an elbow dislocation and other ligament injuries.  Such injuries are called the terrible triad for the reason that treatment can be difficult for a non-upper-limb surgeon.

In some complex fractures of the elbow even after fixation, the elbow remains unstable. In such circumstances, Dr Bala may opt to give you a temporary frame to stabilize the elbow until the ligaments heal. Such frames are either made of titanium and fixed just under the skin (IJO) or are made of carbon fibre and fixed outside the elbow with pins above and below the elbow (Elbow external fixator). Some complex elbow injuries need surgery in stages by fixing the fractures first and repairing or reconstructing the ligaments later.

Strengthening exercises are then recommended after surgery to improve the range of motion.

Elbow fractures when not treated properly can lead to a number of complications including

  1. Non-union (failure of the fracture to heal)
  2. Malunion with deformity or instability (healing of the fracture in a non-functional position)
  3. Stiffness due to soft tissue contracture
  4. Stiffness due to abnormal bone formation (Myositis ossificans)
  5. Post-traumatic arthritis

Rarely the bail out option for failed fixation of the elbow is an elbow replacement. Dr Bala is well versed in total elbow replacement and has attended cadaver workshops for elbow replacement.

Dr Bala specializes in treating fractures that have not been treated properly or have had a suboptimal outcome.