Ask a Doctor: Elbow Fractures

Hand surgeon Benjamin R. Graves, MD answers your questions about elbow fractures.

Of all the joints in the body, the elbow is one of the most complex.  This complexity comes from the fact that the “elbow joint” is made up of three separate joints that form where the humerus, radius, and ulna bones meet.  Under normal circumstances, these three joints work together seamlessly to allow the flexion, extension, and forearm rotation we need to brush our hair and teeth, feed ourselves, turn a door handle, serve a tennis ball, and perform a multitude of other daily tasks.

Fractures involving the elbow can range in severity, from relatively minor injuries that heal on their own, to more severe injuries that require surgery.  Elbow fractures can also lead to a lot of questions for patients and their families.  I have compiled a list of five questions that I am frequently asked regarding elbow fractures.

I hurt my elbow. How do I know if I have an elbow fracture?

Elbow fractures can occur in a variety of ways.  Low-energy injuries, such as falls from standing or bumping the elbow onto a hard object can lead to small, stable fractures that can easily be mistaken for a sprain or strain.  They don’t always cause deformity or instability, and might only cause limited swelling and hurt-to-the-touch in a specific location.  These injuries may hurt for days or weeks and then stop hurting on their own.

Elbow fractures that occur from high-energy injuries, such as falls from heights (for example from a roof or ladder) or motor vehicle collisions, may produce a more intense pain, extensive bruising, and deformity of the elbow.  Some fractures will make the elbow unstable, or cause a dislocation.  When an injury like this happens, it is difficult to “tough it out”, and patients are often unable to use the arm.

Because of this wide range of ways elbow fractures can happen, a good general rule to follow is to follow your instincts.  For smaller injuries (limited bruising, mild-moderate pain, no deformity, able to use the elbow), use the mnemonic RICE: Rest, Ice, Compression, and Elevation.  If the pain improves quickly and function remains intact, it may be okay to restart your regular activities again slowly as symptoms improve.  If the pain persists or if there is any “clicking,” “clunking,” or “catching,” this should be evaluated by a qualified physician.  And as always, if you are concerned or unsure about what to do, see your physician for evaluation.

If there is bruising, a lot of swelling, an elbow deformity, or the pain is severe and seems to be getting worse, it is generally a good idea to have this evaluated sooner rather than later.  X-Rays will likely be obtained to make sure a fracture is not present.

Do all elbow fractures need surgery?

Some elbow fractures, for example those that occur after low-energy trauma, can be managed non-surgically.  If a fracture is stable, or the joint is not involved, it may heal after a short period of wearing a sling and avoiding lifting weight with the arm.  Elbow fractures may require surgery if the bone fragments are not close together, if the bone fragments are in bad alignment, or if the joint is involved.

How soon do I have to have surgery after an elbow fracture?

A fracture starts to heal within days of the injury.  In general, surgery becomes more difficult within a couple of weeks after an injury due to scar tissue formation and early healing of the fracture.  For this reason, it is a good idea to see a physician specialist within a few days of an injury.  This way, if surgery is required, it can be performed while there is the best chance of an optimal outcome.

Can elbow fractures have long-term effects?

• STIFFNESS: Elbow fractures can be complex injuries, not only because of the fractured bones, but because of the soft tissue injuries that can occur at the same time.  For this reason, these injuries can lead to elbow stiffness whether treated with surgery or non-operatively.  You may require extensive physical therapy or even surgery to address this stiffness after the all of the bones have healed.
• ARTHRITIS: Elbow fractures that involve one or more of the three separate joints of the elbow can lead to arthritis due to uneven alignment of the joint surfaces.  Surgery may help decrease the chance of arthritis by aligning the surface of the joint better, however, arthritis can still occur even after surgery.  Incorrect alignment of fracture fragments can also lead to arthritis over time, surgery may help decrease the chances of this.

How can I prevent an elbow fracture from happening?

Elbow fractures often happen without warning during falls or motor vehicle collisions, however, there are a few steps you can take to help prevent fractures from happening:

1. Make sure your bones are healthy. Some fractures occur after a minor injury that might not have occurred with better bone health.  Ask your primary care physician or orthopaedic surgeon about osteoporosis and how you can help prevent fragility fractures from taking place.  Specialized health care teams that focus on bone health are becoming increasingly common.  These teams can perform tests to evaluate your bone mineral density, and recommend physical activities and adjust medications to optimize bone health.
2. Fall-proof your home. Uneven surfaces and poorly-lit walkways can lead to falls.  Make sure there are no loose rugs, and make sure cables or cords are tucked out of walkways.  Night-lights can be used in dark walkways to help illuminate uneven surfaces.  Small steps like these can make a big difference when it comes to preventing fractures.

Benjamin R. Graves, MD is a Board Certified Orthopaedic Surgeon that specializes in treatment of conditions of the Hand, Elbow, and Shoulder.  He is on faculty at Wake Forest University School of Medicine in Winston-Salem, NC, where he holds the academic rank of Assistant Professor.  He serves on the American Society for Surgery of the Hand (ASSH) Diversity and Public Education Committees.