Broken Elbow Facts
Elbow injuries are common in both adults and children. Early recognition and treatment of a fractured elbow injury can reduce the risk of complications and later disability. Any serious injury of the elbow deserves medical attention.
The elbow is a complex joint formed by 3 bones:
- The humerus is a single bone in the upper arm that runs from the shoulder to the elbow.
- The radius and ulna, bones of the forearm run from the elbow to the wrist.
- Ligaments, muscles, and tendons maintain the elbow's stability and allow joint movement.
A normal elbow joint allows these motions:
- Flexion or bending
- Extension or straightening
- Rotation, turning the palm up and down
Serious injuries, such as fractures (a bone break) and dislocations, can damage the bones and other structures of the elbow, resulting in problems with movement, blood vessel function, and nerve function. In children, fractures can affect the growth and development of the bones. This is because children have many bone "growth plates," a part of the bone where bone growth takes place. Bone growth continues throughout childhood; if one of these "growth plates" is involved in a fracture, it can affect bone development.
A fractured elbow is a break that involves one or more of the three arm bones where they work together to form the elbow joint.
What Causes a Broken Elbow?
People can injure an elbow in a variety of ways, from overuse (athletic injuries) to an acute traumatic event (a fall or direct blow). Some common events that result in elbow fractures:
- Falling backward, for example, off a skateboard, the person may attempt to brace the fall with an arm outstretched and open hand.
- High-energy trauma can occur in an automobile or motorcycle collision.
- A direct blow on the elbow can cause a break, such as when a person falls off a bicycle and lands directly on an elbow.
- Sideswipe injury occurs when an elbow is struck while a person is resting an elbow out an open car window.
- Any other direct injury to the elbow, wrist, hand, or shoulder can fracture the elbow.
What Are the Signs and Symptoms of a Broken Elbow?
If the elbow shows any of the following signs, a person may have a fracture, sprained elbow, or another injury that needs medical attention:
- Swelling of the elbow or in the area immediately above or below the elbow
- Deformity of the elbow or the areas near the elbow
- Discoloration, bruising, or redness of the elbow
- Difficulty moving the elbow through its complete range of motion
- Flexion and extension: Individuals should be able to bend their elbow so that they can touch the shoulder with the fingertips. Patients also should be able to fully straighten their arm. If they cannot do this, it may be a sign of a supracondylar fracture.
- Inward and outward rotation: When holding the upper arm at the side with the elbow flexed (bent) at 90 degrees, people should be able to rotate their hand outward so that the palm faces the ceiling. In this same position, a person should be able to rotate his or her hand inward so that the palm faces the floor. If the person cannot do this, it may be a sign of a radial head fracture.
- Numbness decreased sensation, or a cool sensation of the forearm, hand, or fingers
- Three major nerves, 1) the median, 2) radial, and 3) ulnar nerves travel through the elbow. A serious injury may damage one or more of these nerves.
- Many blood vessels also pass through the elbow. These important vessels may become injured or compressed when trauma or swelling occurs in the elbow.
- A cut, or open wound, on the elbow after a traumatic injury
- Severe pain after an elbow injury
- A "tight sensation" in the area of the elbow or forearm
When to See a Doctor for a Broken Elbow
An elbow fracture carries the risk of potentially serious and disabling complications. If a person thinks the elbow may be fractured, seek medical attention at a hospital's emergency department immediately.
If a person has only mild swelling, and no bruising, open wounds, or loss of feeling; they may consider calling a doctor prior to seeking emergency medical attention.
If an elbow shows any of the following problems after an injury to the arm, go to an emergency department if:
- Swelling occurs at or near the elbow
- Any deformity of the elbow or the areas near the elbow.
- The injured elbow has a new lump or bump, go to the emergency department. Compare the injured elbow to the uninjured one.
- Grinding, popping, or clicking is heard or felt during elbow, wrist, or hand movement
- The elbow "catches" at the joint. Normal elbow motion becomes limited.
- Discoloration of the elbow or areas near the elbow occurs. A bluish, purplish, or blackish color may indicate bleeding into, or near, the elbow. A reddish color may be a sign of infection.
- Any numbness or tingling is noticed in any part of the arm, for instance, a "funny bone" feeling that doesn't go away
- The forearm, wrist, or fingers feel "dead" and difficult or impossible to move normally.
- Significant pain in the elbow, forearm, wrist, or hand.
- The wrist, forearm or hand becomes pale, cool, or bluish color that may indicate a blockage of blood flow in the injured elbow.
- Bleeding around the elbow area.
- A person cannot easily perform the following motions without pain:
- Fully straighten the elbow
- Fully bend the elbow so that the fingertips touch the shoulder
How Do Doctors Diagnose a Broken Elbow?
The doctor may perform the following procedures in evaluating a patient for a broken elbow.
- The doctor will generally want to know the patient's overall health history. The doctor may ask questions about past surgeries, medical illnesses, and medications.
- The doctor also may ask several specific questions about the injury as follows:
- What caused your injury?
- When did the injury occur?
- When did symptoms begin?
- What are the major symptoms? For example, only pain, or pain and swelling, or swelling and discoloration, lack of mobility and others?
- The doctor will perform a physical examination, paying particular attention to the injured arm.
- The doctor will probably check the patient's heart, lungs, and abdomen.
- The doctor may also check the patient's head, neck, back, and uninjured arms and legs.
- Most of this examination is to make sure that no other, more serious, injuries or conditions exist. Sometimes people in a great deal of pain from a broken elbow do not even notice that they have other injuries.
- The doctor may order X-rays. Elbow X-rays are taken from the front and side. Additional X-rays, taken at two different angles, may also be done. Depending on the patient's unique health history and their treatment needs, the doctor may order additional laboratory tests.
- Sometimes elbow injuries cause so much pain that a full examination is impossible. If this is the case, the doctor first may choose to simply look at the elbow without moving it or touching it.
- The doctor may examine the hand and wrist to make sure that blood vessels and nerves are working properly.
- In children, the doctor may take X-rays of the uninjured elbow. Children's elbows are not completely formed so growing cartilage, which later forms bone, may be mistaken for a broken bone. Comparing X-rays of injured and uninjured elbows may help the doctor make a correct diagnosis.
- Other tests such as ultrasound, CT scan, and MRI may provide a more complete look at the injured elbow.
- Laboratory tests generally aren't needed for people with broken elbows. If the patient is taking certain medications, have certain health conditions, or requires an operation to repair the broken elbow, additional lab tests may be ordered.
- If the doctor is concerned that the artery that runs by the elbow has been cut, an arteriogram may be recommended.
- In this test, the doctor puts dye into the artery to see if it is damaged.
- A damaged artery may need to be surgically repaired because it supplies all the blood to the wrist and hand.
What Are Home Remedies for a Broken Elbow?
People should seek medical attention if they think their elbow is broken. There is no home care for a broken elbow. Call for emergency help if the injury is severe.
While seeking medical attention, there are some first aid tips that are important to remember.
- Cover an open wound with a clean bandage. If the patient is bleeding, apply firm pressure to the area bleeding, and if possible, raise their arm above their heart and call for help.
- Apply an ice pack or cool compress to the swollen area.
- Transporting a person with a suspected broken elbow requires immobilization the fracture as much as possible. Even a cardboard box, cut to the right size and shape, can be used as a splint.
- Do not attempt to straighten a broken bone. Allow a doctor or trained medical person to attempt to straighten the elbow.
- Do not attempt to push a broken bone back into place if it is sticking out of the skin. Adjusting an arm that appears deformed may worsen the damage to bones or other structures within the elbow.
What Are the Medications for a Broken Elbow?
A wide variety of pain relievers are available for a broken elbow.
- Oral medications are usually used for mild pain.
- Injections, either into a muscle or into a vein (by IV), are used for moderate to severe pain.
- Medication can be put directly into the elbow joint to relieve pain or it can be given by injection or IV.
- If the elbow is dislocated or broken and needs to be reset, medications also can be used to help this process.
- Certain medications relieve pain extremely well, and although they may cause sedation (sleepiness), they allow muscles to relax and help reduce the pain a great deal while the doctor treats the elbow injury.
- After receiving these medications and having the elbow reset, many people awaken to find their elbow has been repaired and splinted.
What Is the Treatment for a Broken Elbow?
Treatment of a broken elbow depends on the type of injury that the patient has suffered.
- Treatment may be as simple as elevating the splinted arm,
- applying ice to swollen areas, and taking pain relievers.
- Treatment can also include surgery to repair bones, nerves, and blood vessels.
Children and adults usually have different types of elbow injuries. They also heal in very different ways, so different treatments are often used for adults and children with broken elbows.
What Is the Surgery for a Broken Elbow?
Sometimes an operation to repair a broken elbow is the best choice. This is particularly true if there is an open or compound elbow injury.
- An open elbow injury means that one or more of the bones at the elbow has come through the skin.
- The bone needs to be put in place and to be thoroughly cleaned so the infection does not occur. This is generally performed by a surgeon.
Elbow injuries that damage nerves and blood vessels often need to be fixed with surgery. The doctor (usually an orthopedic specialist) will discuss the treatment options with the patient.
Other Therapy for a Broken Elbow
- If the elbow joint is filled with blood or other fluid, the joint can be drained.
- Blood or other fluid drained from the elbow may suggest a particular diagnosis to the doctor.
- Draining this fluid may relieve pressure and pain in the elbow.
- Splints, slings, and casts
- Doctors use splints after many different types of elbow injuries. Doctors usually make splints out of plaster. They typically place splints on the back of the arm and do not completely encircle it with the splint material. Splints are designed to hold the elbow in one particular position.
- Splints for broken elbows usually run from near the shoulder all the way to the hand. They prevent the elbow from bending or the hand from turning. Such motions may disturb a healing fracture or a dislocation of the elbow.
- The doctor may provide a sling so the heavy splinted arm can rest comfortably. The doctor may advise removing the sling at home and elevating the arm above the head. Elevating the arm relieves swelling. This is very important especially during the first few days after an elbow injury when swelling may press on nerve and blood vessels in the elbow or forearm.
- Doctors rarely apply casts to freshly injured elbows. A cast, unlike a splint, completely encircles the arm. If swelling occurs underneath a cast, the swelling may cause damage to nerves and blood vessels.
- Resetting broken elbows. If a bone in the elbow is broken or the elbow is out of joint, the doctor may need to reset the bones. This is done for a variety of reasons.
- Putting the bones back in their proper positions may greatly relieve pain.
- Resetting bones also allows proper healing to begin.
- Sometimes broken bones press on, or cut nerves or blood vessels. Moving the bones to their normal positions may stop this damage.
- If the bones of the elbow need to be reset, medications are available to relieve or reduce any pain and anxiety.
What Is the Follow-up for a Broken Elbow?
It is extremely important to follow a doctor's medical advice to get the best possible result. Keep all follow-up appointments.
- Use medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and swelling.
- Elevate the arm to reduce pain and swelling.
- Leave the splint or cast in place.
- Take antibiotics to treat infection, if prescribed, or to reduce the chance of getting an infection.
- Return to the emergency department immediately if any of the following is noticed:
- The hand is cold, pale, or blue
- The hand is numb, tingling, or feels "asleep"
- The forearm hurts when the wrist, hand, or fingers are moved
How Do You Prevent a Broken Elbow?
Most broken elbows stem from trauma such as falls, sports injuries, or motor vehicle crashes. The same common-sense things you would do ordinarily to prevent accidents will help prevent elbow injuries.
- Obey the rules of the road and drive defensively.
- Always wear a seat belt.
- Don't drive with an arm propped on the window or hanging out of the car window.
- Remove household items that may cause trips and falls. Tripping hazards include power cords, small rugs, and footstools.
- Wipe up spills and clean slick floors that might cause a trip and fall.
- Keep walks and driveways ice-free in winter.
While exercising or playing sports
- Always wear proper protective gear while playing sports.
- Don't exercise, practice, or participate when overly fatigued. Injuries tend to happen when people are tired.
- Don't continue an activity if elbow pain develops.
What Is the Prognosis for a Broken Elbow?
The elbow is a very complex joint. Recovery of the elbow after it is broken depends on age and medical condition at the time of injury, as well as the type of injury.
Certain types of elbow injuries are associated with particular types of problems as they heal. Children tend to heal better than adults.
Some of common problems with broken elbows include:
- Infection: Open injuries - when one of the elbow bones comes through the skin-have a higher infection risk. Bacteria can enter the bone or joint and cause infection.
- Stiffness: Many elbow injuries result in elbow stiffness. The injured elbow may not flex, extend, or turn as much as it once did. This usually is more common in adults than in children.
- Nonunion: A broken bone that does not grow back together is called nonunion. Nonunion of a broken elbow can be treated by replacing the elbow with an artificial joint or by bone grafting. Bone grafting involves placing additional bone around the area of the nonunion.
- Malunion: Malunion occurs when healing bones grow back together in an abnormal way. The bone may be bent or twisted. An operation may be required to fix this problem.
- Abnormal bone growth: A broken bone repairs itself by forming new bone. As a broken elbow heals, this new bone may form in areas where bone does not usually grow.
- Arthritis: Arthritis literally means joint inflammation. After a severe injury, people can develop a type of arthritis that may make a joint painful and stiff. This may worsen with cold weather or overuse.
- Nerve damage: The three nerves that run through the elbow can be cut, contused, kinked, or pulled in an elbow injury. The resulting nerve damage may be temporary or permanent. Swelling after an elbow injury can press on nerves causing damage.
- Hardware problems: Doctors sometimes repair broken elbows with wires, pins, screws, plates, and other pieces of hardware. If any of this hardware moves, it may cause pain or unsightly bumps under the skin. If this occurs, the hardware may need to be removed.
- Blood vessel damage: A large artery runs very near the elbow joint to supply blood to the forearm, wrist, and hand. Certain elbow injures may cut or kink this artery. Sometimes resetting the broken elbow will relieve pressure on the artery. Sometimes patients may need an operation to speed recovery.
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REFERENCE: MedscapeReference.com. "Elbow Fracture."