Elbow Injuries

The elbow joint is made of three bones:

The humerus, which is the arm bone
The radius, which is a bone in the forearm, on the outside of your elbow
The ulna, which is the other forearm bone, on the inside of your elbow.

Any one of these bones, or a combination of these bones, can be fractured by an injury such as a fall. Falls can be directly on your elbow, although often people fall directly onto their outstretched hand, with a lot of body weight going through the elbow, causing the injury.

In the elbow joint, the humerus is connected to the ulna and radius as a form of hinge. A heavy fall can dislodge this hinge by damaging the ligaments, and sometimes the bone, that keeps them in contact in the correct position. This is called a dislocation.

Elbow fractures

The elbow joint is made of three bones:

Who gets elbow fractures?

The short answer is anyone! In younger patients, these typically happen as a result of contact sports, including rugby and football. However, they can also happen from any innocent fall from standing height. This is typical in older age groups, especially when people have osteoporosis, which is an age-related weakening of their bones.

Symptoms

01 Bruising and swelling around the elbow after a fall

02 Pain that is worst in the first few weeks, often making it helpful to sleep sitting up slightly and avoid lying on the affected side

03 Difficulty using the elbow until pain subsides

Diagnosis

An elbow fracture or dislocation is often very obvious from the bruising and swelling around the elbow after a fall. Most people visit the nearest A&E and are sent for an X-ray which clearly shows the injury. Sometimes, the injuries are quite complicated and your doctor may request a CT scan to see the fracture in more detail and help to plan treatment.

Treatment options

Non surgical

Sling Treatment

A sling is helpful to help take the weight off your elbow and keep the bone ends in line. For most injuries, it is better to remove the sling as soon as possible to get your elbow moving and prevent future stiffness. Mr. Davies does not recommend wearing an elbow sling for more than 2-3 weeks and often performs surgery to allow earlier movement and prevent excessive stiffness.

The first few weeks are the most painful and it is often helpful to sleep sitting up slightly, and avoiding lying on the affected side. You are advised to take regular painkillers and frequently take your arm out of the sling to move your shoulder, wrist and hand to prevent stiffness.

As the pain subsides, you are able to use your elbow more and more. You are often seen in clinic after a week, and then at 6 weeks to check on healing and, if needed, for a new X-ray. After 6 weeks, if all is going well, you are usually referred to physiotherapy to help get your arm moving properly again. The key is to listen to your body, don't overdo it, and take painkillers.

You can return to work when comfortable. If you work at a desk, this may be after only a week or two. Most people find that they can write and use a computer if they find a comfortable position. Heavier jobs will require more time off work until the fracture has healed. You can return to driving when out of the sling and you feel safe to steer and use the gearstick. This is usually after a minimum of 6 weeks.

If your fracture does not heal after several weeks, your doctor may offer you surgery to try to encourage it to heal. By following your doctor's advice, avoiding smoking and looking after yourself, you can maximise the chance of it healing.

Surgical

Elbow Fracture Surgery

You may be offered surgery to treat the fracture or dislocation. Many fractures can be repaired with a metal plate and screws, along with strong stitches to repair the ligaments. One aim of surgery is to hold the bones around your elbow in place to allow early movement, reducing the chance of stiffness. With surgery, some people are able to get back to normal activities more quickly. However, like all surgery, it carries risks as well as benefits.

Recovery

Many elbow fractures heal reliably without surgery. For example, the commonest type of fracture of the top of the radius usually heals by itself with minimal treatment or long-term consequences. However, the joint is very sensitive to injury and most adult patients do not have a completely normal elbow after recovery, although few people have significant pain or difficulty with their normal activities once they have recovered. The main complications to note are:

Elbow stiffness: As stated above, after full recovery, most adults have minimal or no pain in their elbow and can adapt to do all of their normal activities. However, few people get back to their full movement. Typically, they lose about 20-30 degrees of straightening and about the same bend. Some people have much more movement than this and some have very limited movement. If this happens, your doctor may offer you physiotherapy, and, if all else fails, surgery.

Heterotopic ossification: When you break your elbow, your body tries to heal the bone. Sometimes, your body even makes extra bone outside your elbow during the healing process. This extra bone can block your elbow from moving and in extreme cases may warrant surgical removal.

Failure to heal: Occasionally, however, elbow fractures do not heal by themselves. We call this a non-union. Several factors including smoking, your age and the severity of the injury can affect the chance of your fracture healing. This is an important aspect to discuss with your doctor when deciding on treatment. If it does not heal, it usually remains painful around the fracture and can affect your ability to move your arm. In this situation, you may be offered surgery to fix the fracture and encourage it to heal.

Malunion: This means that the elbow heals but in an incorrect position. This can result in pain or difficulty moving your elbow. It can also excessively stretch a nerve around the inside of your elbow, causing pins and needles and weakness in your hand, known as a tardy ulnar nerve palsy. There may be an option for your surgeon to do an operation that breaks the bone (a so-called osteotomy) to restore it to normal again. If the nerve is affected, it can be released and repositioned to reduce the tension on it.

Instability: If you have dislocated your elbow, there is damage to the ligaments that hold the joint together. Some people have ongoing instability and notice, for example, that their elbow gives way when they lean on their hands with straight elbows. This can be treated with physiotherapy and, in some cases, surgery.

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