Julian Carlo, MD - Hand & Upper Extremity Surgeon

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4 x-rays showing elbow fractures and repairs

Elbow Fractures and Dislocations

What are they?

Elbow fractures are breaks in the bones near or involving the elbow joint. Sometimes, the energy from these injuries is sufficient to damage the joint enough or cause injury to the ligaments and joint capsule such that a dislocation of the elbow joint can result.

What causes them?

These injuries are caused by trauma, direct such as from a blow, or indirect trauma from a fall or twisting mechanism. As such there are many possible types of fractures.  Some fractures around the elbow are best treated with little to no immobilization. Other injuries require surgery to fix the fracture and stabilize the elbow.

How are they treated?

Initial management of elbow fractures involves obtaining x-rays that provide information on the nature and severity of the injury. Some elbow injuries benefit from reduction and splinting to avoid further injury and improve pain. The orthopedic surgeon typically evaluates the nature of the injury, the functional status of the patient, and the xray findings to determine optimal treatment. Often, a CT scan is obtained to better understand the fracture pattern and plan for surgery. The goal of surgery is to provide rigid fixation of the fracture and ensure stability to the elbow joint. This allows the fracture to heal appropriately, prevents the development of arthritis or other complications, and allows the patient to rehabilitate the injury. More severe injuries will typically require close follow up and therapy to ensure a good outcome.

Some examples of injuries around the elbow include:

Olecranon fractures: The olecranon is the part of the ulna bone at the back of the elbow serves as the attachment point for the triceps tendon while forming part of the elbow joint. Conservative treatment is reserved for non-displaced fractures or low demand patients. Usually surgery for fixing the fracture, using plates, screws, and wires, is recommended. Some small fractures involving the triceps tendon may be treated by excising the fracture fragment and repairing the triceps tendon.

Radial head / neck fractures:  The radius is the forearm bone whose rotation around the stationary ulna results in forearm rotation. At the elbow, it forms a joint with ulna and the humerus. The cartilage covered head and the neck just distal to it are often fractured in falls. Many of these fractures can be treated without surgery in a brace or a sling. When fractures are displaced or have many fragments, surgery for fixation of the fracture or for replacement of the head of a radius with a prosthesis is recommended.

Terrible triad: A terrible triad injury to the elbow is a 1) dislocation of the elbow joint combined with a 2) radial head fracture and a 3) fracture of the coronoid process of the ulna. Injury can also occur to the ligaments stabilizing one or both sides of the elbow. To treat this injury, the coronoid fracture is typically repaired, the radial head fracture is fixed or the head is replaced with an implant, and the ligaments are repaired as needed to provide stability to the elbows. Sometimes, instability can persist and additional hardware may be needed to provide stability.

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