In elbow fracture or elbow fracture, the elbow breaks at the top of the ulna where the triceps tendon attaches. One form of elbow fracture is the olecranon fracture. The cause is usually trauma, and therapy is usually surgical with a good prognosis.
What is an elbow fracture?
Schematic diagram showing the anatomy and structure of the elbow. Click to enlarge. An olecranon fracture involves a break in the olecranon, the end of the ulna on the elbow side. This is also the location of the joint of the elbow, which is composed of the two bones of the forearm, radius and ulna, and the lower part of the humerus. To the olecranon, through the tendon of the triceps muscle, the force of the arm extensor muscles is transmitted. Symptoms of elbow fracture occur immediately after the trauma that causes them and include severe pain, bruising with severe swelling of the entire joint, and blue discoloration of the skin around this bruise. Independent movement of the elbow is impossible for the affected person. In some cases, the broken or fractured piece of bone can be palpated as it is pulled upward by the triceps tendon.
Causes
The cause of elbow fracture is most often direct trauma, i.e., a fall backward or to the side that is arrested with the elbow or outstretched arm. If too much force is applied to the weakest part of the elbow joint, it breaks. Mechanically, it can be said that the force of the impact takes hold at the point of least resistance and the joint breaks. Sometimes the trigger is not a fall, but a violent blow with a hard object on the elbow joint. Less commonly, an elbow fracture occurs in pre-damaged bone tissue due to pathological fractures and as a spontaneous fracture. Other causes can be increased stress, so that a fatigue fracture of the joint occurs. Patients at risk of this are primarily those with brittle bone disease, osteoporosis, bone tumors, and metastases.
Symptoms, complaints, and signs
Elbow fracture is an extremely painful condition that is usually triggered by an external event, such as a violent fall on the elbow. Immediately after this event, a very severe pain occurs. A doctor should be consulted for a doubtless diagnosis of the fracture and subsequent treatment. The fracture of the elbow involves almost complete loss of movement of the arm in the elbow joint. The arm can no longer be bent or flexed, and very severe pain occurs when trying to do so. At the same time, the joint swells very quickly very much, also the formation of hematomas is possible. If an elbow fracture is not treated, it can lead to complete irreversible stiffening of the arm and to all kinds of subsequent orthopedic problems. Therefore, professional therapy is absolutely mandatory. Very often, a fracture of the elbow is a so-called open fracture. The skin over the joint and bone is very thin, and can be pierced very easily by a sharp splintered or broken bone. In such cases, the bone protrudes visibly from the open wound and the fracture can be diagnosed without doubt even by the layman. In addition, there may be moderate blood loss. The elbow fracture is also a painful condition during the healing process and requires extensive physiotherapy rehabilitation and prolonged exercises.
Diagnosis and course
If severe pain that restricts movement, a bruise, and swelling occur at the elbow joint after a fall, the patient should consult a physician immediately. After taking a detailed medical history, the doctor will examine the elbow joint. This is followed by an X-ray. This and, if necessary, other examinations are intended to rule out concomitant injuries to blood vessels, ligaments, tendons and nerves. Prompt medical attention is critical to successful treatment, because the strong pull of the triceps muscle shifts the fracture fragments against each other, making the deviation more severe over time, more difficult to operate on, and increasing the risk of late effects and permanent damage. In general, there is a good prognosis after an olecranon fracture, and complications are rare. However, there is often a reduced load-bearing capacity on stronger stresses, such as tennis, rowing or golf.More complicated comminuted fractures with multiple fragments can lead to joint irregularities, premature joint wear, and limited joint mobility despite early treatment.
Complications
If an elbow fracture is treated promptly by a physician, no major complications usually occur. However, late effects cannot be completely ruled out. For example, after surgery, the load-bearing capacity of the affected bones and muscles is sometimes reduced. Long-lasting restrictions can occur, especially in sports activities such as golf, rowing or tennis. As a result of a comminuted fracture, for example, irregularities can occur in the joint. This can result in joint wear and tear years later, which is associated with limited mobility of the elbow. A multiple or displaced fracture also sometimes leads to joint stiffness and chronic joint instability. Degeneration of the cartilage and joint can lead to chronic inflammation and severe pain. As the disease progresses, arthrosis or pseudoarthrosis may result. Injuries to arteries and nerves also cannot be completely ruled out in elbow fractures. If nerves are injured in an elbow fracture, numbness and sensory disturbances may occur. There is usually also a loss of strength and sensitivity, which can extend from the elbow to the little finger. Movement restrictions may also occur, but usually disappear on their own.
When should you see a doctor?
If severe pain and restricted movement occur in the elbow area after an accident or fall, an elbow fracture may be present. A visit to the doctor is advisable if the discomfort does not subside on its own and there are other signs of a fracture. If, for example, bruising, swelling and bruises are noticed, this requires medical clarification in any case. In case of further impairments such as circulatory problems or intense pain, the ambulance service should be called. In any case, an open fracture must be examined and treated immediately by a physician. Depending on the severity of the elbow fracture, the affected person must then spend several days to weeks in the hospital. During this time, the doctor will closely monitor whether the tendons, nerves and muscles are growing together properly and, if necessary, order further measures such as physiotherapy or surgery. After the patient leaves the hospital, regular follow-up visits are indicated. If bleeding, scar pain and other complications develop, this requires prompt clarification by the physician in charge.
Treatment and therapy
Until medical examination, the arm should be splinted, relieved, and cooled. Conservative therapy by means of immobilization is only possible if the elbow fracture is stable. This means that there should be a maximum of two millimeters between the fracture pieces and that they are not displaced. Immobilization is usually performed only in children. Displaced olecranon fractures require surgery. Comminuted fractures require the use of a small plate, which may be combined with tension taping. Tension taping is the most common treatment for olecranon fracture. In this procedure, the fracture fragments are held in place by an assistant while the surgeon sutures the bone with a wire in an octagonal shape. This surgery is usually performed under general anesthesia. Some fractures can be treated after surgery without immobilization. As a rule, however, a plaster cast is applied for about six weeks. During this time, the elbow joint must not be loaded. For several weeks to months after the operation, discomfort may still occur when resting the elbow, making it necessary to wear an elbow protector. Physical therapy helps rebuild the triceps and elbow joint after weeks of immobilization.
Outlook and prognosis
An uncomplicated elbow fracture is one of the most common bone fractures. It usually has a good prognosis because it is one of the routine operations performed very frequently in hospitals. It becomes more difficult if the joint was also damaged during the fracture, or if the fracture causes injuries in the soft tissue and blood vessels. If the tissue is no longer supplied with sufficient blood, parts of it can die.An elbow fracture also has a less favorable outlook if parts of the bone do not grow back together properly. Even minor displacements result in faulty statics, which in the long term leads to incorrect loading of the elbow and promotes wear and tear of the joint. Despite a generally good prognosis, it is possible that sports that place a heavy load on the elbow (such as squash, tennis or golf) can no longer be practiced as they were before the fracture. Muscle strength and muscle mass have been lost due to prolonged immobilization of the arm. In most cases, targeted physiotherapy exercises are then necessary to restore muscle strength, especially if patients are elderly.
Prevention
General prevention is difficult because falls tend to happen accidentally. However, responsible and health-conscious athletes wear well-fitting and risk-minimizing elbow pads that are replaced after each fall.
Here’s what you can do yourself
In the event of an elbow fracture, the emergency physician must be notified immediately. Until professional help arrives, the elbow should be spared and, if possible, not moved. A closed fracture can be cooled with an ice pack or cold pack. Open fractures are covered with a germ-free dressing if possible. To prevent worsening of the fracture, further treatment should be provided by the emergency physician. Healing of the bone can be promoted by exercise and a healthy, balanced diet rich in calcium and iron. However, the elbow itself should be spared until the doctor gives the okay to return to exercise. During the period of rest, gentle massages and sauna sessions are recommended. Both promote blood circulation and thus the healing process. In consultation with the doctor, alternative treatment methods such as ultrasound therapy or electrotherapy can also be tried. Proven remedies from naturopathy include the decongestant arnica, the healing-promoting comfrey and the Schüßler salts calcium fluoratum and ferrum phosphoricum. Treatment with the patient’s own blood can also promote the healing process, but should always be done under the supervision of a physician.
