Symptoms
A fracture of the elbow is relatively painful in the first moment – like any other fracture. This is because the fine periosteum surrounding our bones is stretched and pierced. The periosteum is permeated by many small, fine nerve fibers and is extremely sensitive to pain.
Fortunately, the pain subsides as soon as the fracture site is no longer strained. This is harder for some fractures than others, the olecranon is mainly stressed during stretching movements of the elbow. This is because a very strong muscle, the triceps brachii muscle, has its base at the olecranon and pulls on it with every stretching movement.
However, as long as the arm is not stretched out or the elbow is pushed, the pain is usually bearable. However, an important distinction between elbow fracture and elbow joint fracture is passive mobility. If the examiner passively moves the forearm, the pain should be less severe in the case of an elbow fracture than in the case of forced, active movement.
Strong pain during passive movement was more likely to indicate involvement of the joint surfaces of the elbow joint. In addition to the pain, and the reduced mobility, swelling and redness are typical. Since fine blood vessels run under the skin, blood from the ruptured vessels leaks into the subcutaneous tissue in the event of a fracture.
The result is the typical “bruises” that each of us has had at some time or another. If a larger vessel has been injured, this can lead to regular bruising. These are not serious as long as not too much blood is lost in the arm.
From a certain amount of blood loss (approx. over 0.5 liters), depending on the constitution and age, circulatory problems and shock symptoms can occur. Since up to one liter of blood can be lost in the arm, injury to large vessels can be ruled out in an emergency.
The therapy depends on the pattern of injury and is usually carried out surgically. The operation again depends on the type of elbow fracture.If the olecranon is fractured into many different parts, plate osteosynthesis is usually used. A plate is implanted under the skin, on the bone, and the individual bone fragments are screwed to the plate like a puzzle.
Of course, it is important – just like in a puzzle – to put the bone fragments in their original position, otherwise malpositioning and crooked fusion can occur. The plate, like the screws, is usually made of titanium. They are usually removed from the body within 12 months of the fracture.
Much longer waiting times are not recommended, since the bone grows into the plate over time and the screws can break off when they are removed. In certain cases, however, the plating can be left in the body. A stable supply of the elbow fracture is necessary in any case, since the tendon of the triceps muscle attaches to its posterior side.
This strong muscle is responsible for stretching the arm and exerts great force on the bone. For this reason, the healing time for an elbow fracture is given as up to two months, i.e. two weeks more than is usually the case with bone fractures. In the event that there is no fracture of the olecranon, but a separation from the remaining part of the ulna, the surgeon uses a so-called screw osteosynthesis.
From the name of the procedure it can already be deduced that a bone (Latin “os”) is to be synthesized, i.e. connected, by means of a screw. In this process, the piece of bone that has been removed is screwed to the remaining intact bone. This is almost like screwing a door knob to a house door from the outside.
Of course, the whole process is a little more complicated for humans than for a house door, because nerve tracts and vessels can be injured and permanent damage can occur. For this reason, screw osteosynthesis is always performed under the control of an X-ray machine. First, a hole is usually predrilled and a wire is inserted, which is black from the white bone mass in the X-ray.
This ensures that the screw is later placed in the correct position. Once the hole has been predrilled in the correct position, a titanium screw is now screwed into the predrilled hole. There is a large variety of thicknesses, diameters and threads, each of which is individually selected by the surgeon for the patient.
Severe fractures, or the combination of comminuted fracture and dislocation, may require simultaneous screw and plate treatment of the elbow fracture. In any case, the arm must be immobilized for 6-8 weeks. The immobilization is done by means of a plaster cast, and so-called “Gilchrist dressing”.
This is the name given to the bandage that classically holds the arm at a 90 degree angle in front of the body and is wrapped around the patient’s neck. An operation is not always necessary, however: If the fracture is only minimally displaced or not displaced at all, conservative immobilization may be sufficient. It is always necessary to weigh up how the elbow fracture will heal.
Displacement is still tolerable up to a small degree, but if the bone pieces are too much displaced, conservative treatment will result in a subsequent malposition. Over the years, this causes incorrect loading of the elbow joint and accelerated wear and tear. Bone and joint are virtually the foundation of the elbow. If the statics at this point are disturbed, sooner or later problems will occur in the entire arm.
