The bones of the elbow are susceptible to injury and fracture just like any other part of the body. If a serious injury occurs, this may result in fracture of one or more of the elbow bones including the radial head, olecranon (tip of the elbow), or the distal portion of the humerus. The type and degree of disruption of the fracture typically dictate treatment, which may range from nonoperative and attempted early motion, to extensive surgery to restore the normal anatomy of the elbow.
What is a radial head fracture and how is it treated?
The most common elbow fracture involves the radial head, typically as a result of a fall onto an outstretched arm. This fracture results in pain and swelling within the elbow causing difficulty rotating the forearm as well as with straightening and bending the elbow. Commonly, these fractures can be treated without surgery by initiating motion exercises. However, if the fracture causes disruption of the joint surfaces (an intraarticular fracture) it may require fixation with surgery that uses screws to hold the bones in the correct anatomical position as it heals. Sometimes, the fracture is so severe that replacement of the bone is required with a metal implant, called a radial head arthroplasty.
What is an olecranon fracture and how is it treated?
The olecranon is the point of the elbow and is considered the proximal portion of the ulna. The triceps muscle, which is responsible for actively straightening the elbow (extension) attaches to the olecranon. This bone may be fractured from a direct fall onto the point of the elbow or a fall onto an outstretched hand. Most commonly, this fracture results in a significant disruption of the ability of the elbow to extend actively and requires surgery. Typically, this fracture is fixed with a plate and screws. Often after surgery, the patient is encouraged to begin active motion almost immediately.
What is a distal humerus fracture and how is it treated?
The distal humerus is the portion of the upper arm bone that makes one side of the elbow joint. This bone connects (articulates) with both the ulna and radius, and also functions as the origin for both of the major ligaments of the elbow, the MCL and LUCL. Typically, a distal humerus fracture results from either a fall or a high energy mechanism such as a car accident or fall from height. Often, these fractures involve the joint surface and most will require surgical fixation. The benefit of surgical fixation is restoration of the normal anatomy of the elbow, which also allows for immediate mobilization of the elbow that helps to prevent stiffness. Surgery for distal humerus fractures typically utilizes a surgical incision along the back of the elbow that allows for the placement of up to two plates and screws along the elbow to stabilize the fracture.
What are elbow fracture dislocations and how are they treated?
In very severe elbow injuries, the elbow may sustain a fracture of the bones with an associated disruption of the ligaments. This is a serious injury that results in major disruption of the elbow joint and if not treated appropriately may result in long term dysfunction of the elbow. These fractures are commonly known as “terrible triad” fractures, because they result in disruption of three structures: fracture of the radial head, fracture of the coronoid (the coronoid is a portion of the proximal ulna that helps to provide stability to the elbow joint), and disruption of the lateral ligament. In addition, they are termed “terrible” because if not addressed appropriately they can have poor outcomes.
Surgery is almost always required for these injuries to restore stability to the joint and allow for early motion to avoid stiffness. Surgery begins with an incision along the back or side of the elbow. The lateral ligament is identified and repaired to the humerus with suture. The radial head is fixed with screws unless it is highly damaged, then a replacement radial head is utilized. The coronoid fracture can be fixed with either suture or screws. Typically, the patient remains in the hospital overnight after surgery, and a drain may be placed into the surgical incision to remove extra bleeding. Depending on the stability of the repair, we try to allow the patient to move the elbow as soon as possible to prevent stiffness. Commonly, the patient is placed into an elbow brace that allows for motion but provides stability (hinged elbow brace). This is kept on for 6 weeks and then progressive weight bearing is initiated. Patients may improve with motion and strength for up to 1 year from surgery.