Fractures around the elbow
A fracture is a break in the continuity of the bone, usually due to injury. A break is a fracture and vice versa. They can be displaced or undisplaced; open – if the skin is breached, or closed – if the overlying skin is intact; or they can be into a joint (intra-articular) or away from the joint (extra-articular). Signs of fracture include swelling and bruising, significant pain, stiffness and a story of a crack or pop at the time of injury. Deformity of a limb usually results from displaced fractures or dislocation of a joint.
How are fractures around the elbow diagnosed?If there is concern about a potential fracture from the history and clinical examination, an X-ray will be arranged. The three bones that meet at the elbow are the humerus (upper arm bone), the radius and the ulna (the forearm bones) and any of these can be involved. If the fracture is complex, or a dislocation has occurred, a CT scan may be arranged.
What fractures are commonly seen and how are they treated?With all elbow fractures, the goal is to achieve pain relief and as much range of motion and function from the elbow. The most common fractures are:
- Radial head fractures
- Olecranon fractures
- Distal humeral fractures
- Coronoid fractures
- Fracture dislocations
The radial head is located within the capsule (lining) of the elbow joint and allows forearm rotation due to its shape. A fall onto an outstretched hand may result in a radial head fracture.
Diagnosis is by X-ray and treatment depends on whether there is displacement of the bone. Undisplaced fractures are treated with painkillers and a sling for comfort only. Early mobilisation is encouraged to reduce the risk of elbow stiffness. If there is displacement of the fracture that prevents or blocks rotation of the arm, surgery to either fix or replace the radial head is discussed.
The olecranon is the part of the bone that forms the tip or point of the elbow. It allows the elbow to bend and straighten due to its shape, and forms the lower part of the elbow joint hinge. Undisplaced fractures can be treated with surgery, but the majority of displaced olecranon fractures are treated with surgical fixation, either with wires or a plate and screws.
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Distal humerus fractures
The distal humerus is the lower end of the upper arm bone (humerus), which forms the upper part of the elbow joint. The bone can be fractured in many ways. If the fracture is undisplaced then non-surgical treatment may be appropriate.
The majority of these fractures require surgery to put the bone fragments back into alignment to give the elbow the best chance of moving; they are fixed with plates and screws.
In fractures that result in many bone fragments, fixation may be impossible. In younger patients, half elbow replacements (distal humeral hemi-arthroplasty) may be offered. In more elderly patients, with poorer quality bones and tissues, total elbow replacement may be needed.
Elbow fracture dislocations often need surgical intervention as the fractures and ligament injuries need to be addressed, however each case must be assessed individually. If surgery is performed the fractures will either be fixed with plates and screws, or parts of the elbow can be replaced (radial head). Any ligament damage that needs it will be repaired at the same time.
What are the problems following fractures around the elbow?Stiffness
The elbow does not tolerate injury well and often the joint gets some element of stiffness following fracture or surgery for fractures. This is often mild and well tolerated due to the large range of movement of the shoulder, hand and wrist that will compensate for the lack of movement. Occasionally surgery is offered for stiffness after fracture.
Heterotopic ossification (HO) is new bone formation in the soft tissues seen rarely after injury or fracture or surgery. This can lead to stiffness of the joint, and as it produces a mechanical block to movement, surgery can be performed to remove the new bone formation. HO is rare and surgery is generally delayed until the new bone has matured.
If a fracture involves a joint (intra-articular), there is a risk of developing post-traumatic arthritis of the joint. Elbow arthritis may occur soon after fracture, but can develop many years following the injury as the joint surfaces wear away over time. Painful elbow arthritis can be treated by either surgical or non-surgical means.
A big thank you to Simon and his team for their care, patience and perseverence looking after me through all stages of both shoulder and elbow surgery.
Since the shoulder stabilisation I have continued my sailing and fitness training without the worry that my shoulder might dislocate; and I don’t have to think twice whether my ulnar nerve will hinder any progression in my sports.
With their amazing help, I’ve been able to get back to sailing competatively and am now a double National champion.
After multiple shoulder dislocations Charlie helped me set a route for recovery, which has been nothing but smooth sailing. Surgery went successfully and I am well on my way to playing the sports I was previously. Would highly recommend.
Simon successfully operated on my frozen left shoulder in 2012 with fantastic results. This year he has overseen and advised treatment for my frozen right shoulder (via hydrodilation injection). His unrivalled experience in orthopaedic shoulder treatments, coupled with his reassuring bedside manner and excellent results, gave me huge confidence throughout. I’m hugely grateful to have my quality of life back and wouldn’t hesitate to recommend his services. Thank you Simon.
I had suffered with a painful shoulder and pins and needles for three years following a right shoulder fracture and failed half joint replacement prior to meeting Mr Pennington. He explained the situation in a way I could relate to and I’m delighted to say my revision shoulder replacement has gone well and for the first time in years I can use my arm and am pain free. I was even able to walk my daughter down the aisle 3 months after surgery! Many thanks.
I would like to thank Charlie Talbot and his team for the operations performed on both my shoulders and also the aftercare put in place after my operations. I have played golf since I was 12 years of age and thought at one point that I would never get back to playing again. Charlie was always very positive and told me that he would get me playing golf again. Well, I have now been playing golf for nearly 2 years. Before surgery I had a handicap of 12 and I am now down to 9, not bad at the age of 68. So many many thanks.
I had PRP injections into my right elbow last year and within 3 months I was pain free, a year on it is more or less 100% better. Fabulous I would recommend it to anyone with Tennis Elbow, in fact I have gone back again this year to get my left elbow done. Thanks Simon.
Mr Pennington I really wanted you to know how very thankful I am for the excellent care & treatment you and your staff gave me. It really meant a lot that you were so clear, friendly & professional and listened to me – so thank you again.
After more than four decades of shoulder problems with a total of three surgeries the full shoulder replacement surgery by Mr. Talbot has changed my life beyond expectations. I am now able bodied for the first time in years and pain free.
Thank you to Mr Boyle and team for the excellent care and attention both before and after Replacement Shoulder surgery, using the Tornier Simpliciti procedure. After very many months of severe pain and lack of movement I was pain free from day one. Now, after nine weeks, the shoulder and arm movement continues to improve, beyond expectation, with physiotherapy and exercise. I am extremely grateful for all the continuing care.
Following two years of recurrent problems with my left shoulder I was recommendedto Consult Mr Neil Pennington. I had the opportunity to have my surgery quickly and at my convenience, this fitted well around my professional and home commitments. The surgery was carried out as a day case procedure and Mr Pennington visited me following the surgery to explain everything. My operation was a minimally invasive procedure so my recovery was straightforward with only a few restrictions; in fact I was encouraged to keep my shoulder moving. I was driving and back to work after 2 weeks – after 2 years of pain and sleep disturbance I found this operation to be life changing! I found Mr Pennington to be a very professional and compassionate surgeon and he is surrounded by a whole team of professionals that gave me the utmost confidence in the care and treatment I received.
I would like to thank Mr. Talbot and the amazing team of nurses, physiotherapists and support staff for their care and support during my recent visit to the Duchy Hospital, Harrogate, for a replacement shoulder. The care and attention I received was unparalleled. The pain free movement I now have has changed my life.