What Is An Elbow Fracture?

Overview

An elbow fracture (also called a broken elbow) is a break or crack in one or more of the three bones that make up the elbow joint: the ulna, radius and humerus. The ulna and radius are the forearm bones, positioned between the elbow and wrist. The humerus is the upper arm bone that connects the elbow to the shoulder. 

These three bones meet at the elbow and form a complex consisting of three articulations that bend and straighten the elbow as well as rotate the lower arm, allowing the palm to be turned up and down. The bones create three separate articulations that make up the elbow complex:

• The humeroulnar joint - the humerus with the ulna 
• The radiohumeral joint - humerus with the radius
• The proximal radioulnar joint - the radius with the ulna¹ 

Types of elbow fracture

There are a number of different types of elbow fracture. The primary classification is made by the bones involved. Common examples are:

• supracondylar fracture of the distal humerus (fracture at the end of the humerus bone just above the elbow)
• olecranon fracture (fracture of the bony prominence of the ulna bone at the tip of the elbow)
• radial head fracture (fracture of the top of the radius bone, just below the elbow)¹

Fractures are also classified depending on whether the break or crack extends into the joint surfaces or not. Extra-articular fractures involve a break in one of the bones near the joint but not extending into the joint itself. Intra-articular fractures involve a break that extends into the joint, which may result in damage to the cartilage covering the joint surfaces. 

Some types of elbow fractures are more common in certain age groups or with certain mechanisms of injury. Supracondylar fractures of the humerus are the most common elbow fractures in children.² Radial head fractures are the most common type in adults and often result from a fall onto an outstretched hand.^{3, 4, 5 6}

The injuries that cause elbow fractures can also result in elbow dislocation (when the two ends of a bone meeting at a joint are forced apart and out of normal position) or subluxation (partial dislocation) at the same time. 

Alongside the break or crack in the bone, there may also be damage to the surrounding soft tissues such as the ligaments, muscles, tendons, nerves and blood vessels. 

Causes of elbow fracture

Fall onto an outstretched arm are common mechanisms of injury that result in elbow fractures, as well as direct falls onto the elbow joint. In younger children, these injuries may result from falls occurring indoors during normal activities. In older children, elbow fractures occur most often from falls whilst skateboarding, caster-boarding, cycling or other outdoor activities.²

Other mechanisms of injury include a direct blow to the joint, a twisting or sideways bend of the arm, or a throwing injury. Fractures in healthy bone, in adults, are often caused by injuries involving significant force, such as falls or direct impact during cycling or contact sports. 

Those with poor bone strength due to age or other existing conditions can incur fractures more easily, with less force involved.⁷

Signs and symptoms of elbow fracture

Signs and symptoms of a fractured elbow include:

• pain/tenderness
• swelling
• stiffness/loss of movement
• bruising
• visible deformity
• numbness in elbow area, forearm, hand or fingers 

Management and treatment for elbow fracture

Management of elbow fracture will depend on the type of fracture (including its location and severity), the degree of soft tissue damage, as well as the age of the patient and their general state of health. 

Simple breaks that are not displaced fractures (not out of alignment) may be managed conservatively (without surgery). In these cases, a form of immobilisation is usually applied, such as a splint, cast or sling to keep the bones still in the initial phases of healing.⁴

Some fractures are more severe and complex, such as those that are displaced (out of alignment) or open (where the broken bone pierces the skin). These usually require orthopaedic surgery to unite bones or restore bone fragments to their correct positions and keep them in place whilst they heal. This may involve insertion of screws or plates, bone grafting, or replacement of the radial head. 

Elbow fracture surgery may also involve the repair of damaged soft tissues, such as the joint capsule, ligaments or tendons, in order to aid healing and prevent elbow instability.⁸ 

Additionally, surgery may be needed for patients who present with signs of neurovascular compromise (signs and symptoms that indicate blood vessel or nerve injury). These require urgent medical attention by an Orthopaedic surgeon.⁹ 

Severe damage to the elbow joint can require a full elbow joint replacement.

Elbow fractures will typically require rehabilitation and physiotherapy to restore movement, strength and function, as these are often reduced following injury and immobilisation. This usually involves a programme of exercises and advice, often overseen by a physiotherapist. In addition to the elbow itself, treatment may target the adjacent joints of the wrist and shoulder.¹⁰

Pain experienced from the injury or surgery is typically treated with ice, elevation and pain medication.

Diagnosis

Diagnosis of a fractured elbow typically involves:

• physical examination
• details of injury mechanism
• X-ray 

Suspected fractures that are not visible on X-rays may require CT (computerised tomography) or MRI (magnetic resonance imaging) scans as these can show a greater level of detail.⁴

Complications

Many elbow fractures will heal fully without complication. However, some people may experience non-union (failure of a fracture to heal properly) or malunion (healing of a fracture in an abnormal position) of the bone(s). This may require treatment with surgery. 

In addition, elbow fractures can result in a loss of stability, restriction to the range of movement and reduction in strength at the elbow joint. 

Loss of full movement of the elbow is significant as this can reduce the ability to position the hand in space and reach all parts of the body.¹¹ The movement most likely to be reduced after elbow fracture is elbow extension (elbow straightening).¹⁰ 

Loss of full elbow flexion (elbow bending) is less common, but this can more significantly impact on function, as it may result in the inability to reach the face and mouth.¹²

More complex fractures, such as intra-articular fractures which result in damage to the joint surfaces, increase the risk of development of osteoarthritis (degenerative joint disease) later in life.¹³

Factors affecting the likelihood of complications following elbow fracture include the severity and location of the fracture, the length of time between injury and rehabilitation, the compliance of the patient with the designated exercise programme, and the presence of other health issues.¹⁰

FAQs

How can I prevent elbow fracture?

Elbow fractures are commonly caused by falls or by a direct blow to the elbow. Falls onto an outstretched arm with the elbow straight are the most common mechanism of injury.⁴

In young children, these injuries can occur from relatively low-impact activities and so are difficult to prevent. 

Older children and adults are more likely to incur these fractures during activities such as skateboarding/caster boarding, cycling or contact sports. Preventative measures could therefore include appropriate safety training and use of protective equipment.² 

Poor bone strength associated with older age increases the risk of bone fracture resulting from a fall.⁷ The likelihood of falling increases with age in older adults due to a number of different factors. Prevention of falls in this age group can therefore reduce the risk of fractures. Further information on fall prevention can be found here.¹⁴ 

How common is elbow fracture

Elbow fractures are relatively common and account for 4.3% of all fractures.⁹ They occur more frequently in children than in adults.¹⁵ The American Association of Orthopaedic Surgeons estimates that 10% of all childhood fractures involve the elbow. 

Who is at risk of elbow fracture

Elbow fractures are most common in children and often result from normal childhood activities. 

Elbow fracture injuries in adults occur most often during activities such as cycling or contact sports.

The elderly population is at a greater risk of broken bones in general due to their bone fragility.⁷

When should I see a doctor

The main symptoms of elbow fracture are pain, swelling, deformity, bruising and reduced movement of the joint. There may also be numbness in the forearm, wrist or hand. The most common mechanism of action is a fall onto an outstretched arm. If you have any of these symptoms, particularly after experiencing a fall or an injury to the elbow area, consult a healthcare professional. 

Summary

Elbow fractures are a relatively common injury, particularly in children. The elbow complex involves three different bones and three closely-linked articulations and injuries can therefore involve damage to several different structures. Treatment options for a fractured elbow may be conservative or surgical, depending on the type of injury and other factors. Rehabilitation is commonly used to regain strength and movement of the elbow joint, essential to the overall function of the upper limb.