Broken Elbow

Broken Elbow Overview

Elbow injuries are common in both adults and children. Early recognition and treatment of an elbow injury can reduce the risk of complications and later disability. Any serious injury of the elbow deserves medical attention.

  • Your elbow is a complex joint formed by 3 bones:
    • The humerus is a single bone in your upper arm that runs from your shoulder to your elbow.
    • The radius and ulna, bones of your forearm, run from the elbow to the wrist.
    • Ligaments, muscles, and tendons maintain your elbow's stability and allow joint movement.
  • A normal elbow joint allows these motions:
    • Flexion, or bending
    • Extension, or straightening
    • Rotation, turning your palm up and down
  • Serious injuries, such as fractures (a bone break) and dislocations, can damage the bones and other structures of your 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 centers," a part of the bone where bone growth takes place. As bone growth continues throughout childhood, if one of these "growth centers" is involved in a fracture, it can affect bone development.
  • An elbow fracture is a break that involves 1 or more of the 3 arm bones where they work together to form the elbow joint.

Broken Elbow Causes

You can injure your 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 include:

  • When you fall backward, off a snowboard for example, you may attempt to brace the fall with your arm outstretched and your hand open.
  • High-energy trauma can occur in an automobile or motorcycle collision.
  • A direct blow on the elbow can cause a break when you fall off a skateboard or bicycle and land directly on an elbow.
  • Sideswipe injury occurs when an elbow is struck while you are resting your elbow out an open car window.
  • Any other direct injury to the elbow, wrist, hand, or shoulder can affect the elbow.

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Broken Elbow Symptoms

If your elbow shows any of the following signs you may have a fracture or another injury that needs medical attention.

  • Swelling of your elbow or in the area immediately above or below your elbow
  • Deformity of your elbow, or the areas near your elbow
  • Discoloration, such as bruising or redness of your elbow
  • Difficulty moving your elbow through its complete range of motion
    • Flexion and extension: You should be able to bend your elbow so that you can touch your shoulder with your fingertips. You also should be able to fully straighten your arm.
    • Inward and outward rotation: When holding your arm at your side with your elbow flexed (bent) at 90°, you should be able to rotate your hand outward so that your palm faces the ceiling. In this same position, you should be able to rotate your hand inward so that your palm faces the floor.
  • Numbness, decreased sensation, or a cool sensation of your forearm, hand, or fingers
    • Three major nerves-the median, radial, and ulnar nerves-travel through your elbow. A serious injury may damage these nerves.
    • Many blood vessels also pass through your elbow. These important vessels may become injured or compressed when trauma or swelling occurs.
  • 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 your elbow or forearm

When to Seek Medical Care

An elbow fracture carries the risk of potentially serious and disabling complications. If you think your elbow may be fractured, you should seek medical attention at a hospital's emergency department immediately.

If you have only mild swelling, and no bruising, open wounds, or loss of feeling, you may consider calling a doctor prior to seeking emergency medical attention.

If your elbow shows any of the following problems after an injury to your arm, you should go to an emergency department.

  • You have swelling at or near the elbow.
  • You notice any deformity of the elbow or the areas near the elbow.
  • If you have any doubts, compare your injured elbow to your uninjured one. If you have a new lump or bump, go to the emergency department.
  • You hear or feel grinding, popping, or clicking as you move your elbow, wrist, or hand.
  • Your elbow "catches" at the joint.
  • Your normal elbow motion becomes limited.
  • You see any discoloration of the elbow or areas near the elbow. A bluish, purplish, or blackish color may mean you are bleeding into, or near, your elbow. A reddish color may signal infection.
  • You notice any numbness or tingling of any part of your arm, for instance, a "funny bone" feeling that doesn't go away
  • Your forearm, wrist, or fingers feels "dead" and difficult or impossible to move normally.
  • You have any significant pain in your elbow, forearm, wrist, or hand.
  • You notice any color or temperature change in your forearm, wrist, or hand.
  • Your wrist or hand is pale, cool, or bluish. You may have a blockage of blood flow in your injured elbow.
  • You are bleeding around the elbow area.
  • You should be able to easily perform the following motions without pain:
    • Fully straighten your elbow
    • Fully bend it so that your fingertips touch your shoulder
    • Turn your palm completely toward the ceiling and toward the floor

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Exams and Tests

The doctor may perform the following procedures in evaluating your broken elbow:

  • The doctor will generally want to know your overall health history. Some of the questions will ask for this information:
    • Your age
    • Your handedness (Are you right-handed or left-handed?)
    • Your profession
    • Your level of activity (Are you an athlete or a desk worker?)
    • The surgeries and injuries you have had, particularly on your elbow or your hand
    • The medical illnesses or conditions you have had (Illnesses or medical conditions that may affect bones, joints, ligaments, tendons, muscles, nerves, and blood vessels are very important. Problems you have had with bleeding or healing are important also.)
    • The medical illnesses or conditions you now have
    • The medications you take
    • The medication allergies you have
    • The social habits you have (whether you smoke cigarettes or drink alcohol)
  • The doctor also will ask specific questions about your injury.
    • What caused your injury? For example, did you fall or did something hit your elbow? If you fell, was it onto your hand or directly onto your elbow?
    • When did the injury occur?
    • When did your symptoms begin?
    • What symptoms have you noticed? For example, have you had pain, or pain and swelling, or swelling and discoloration?
  • The doctor will perform a limited physical examination, paying particular attention to your injured arm.
    • The doctor will probably check your heart, lungs, and abdomen.
    • The doctor may also check your 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 basic x-rays. Depending on your unique health history and your treatment needs, the doctor may order additional laboratory tests or specialized x-rays.
    • Sometimes elbow injuries cause so much pain that a full examination is impossible. If this is the case, the doctor first may choose to look at your elbow without moving it or touching it.
    • The doctor may examine your hand and wrist to make sure that blood vessels and nerves are working properly.
    • The doctor then may decide to treat your pain and get some x-rays. Often after pain is relieved (by splinting or giving pain medications), a more complete and reliable examination is possible.
    • Basic elbow x-rays are taken from the front and side. Additional x-rays, taken at 2 different angles, also are routine.
    • In children, the doctor may take x-rays of the other, uninjured, elbow. Children's elbows are not completely formed of bone. 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 diagnos
    • Other images that are like x-rays-ultrasound, CT scan, and MRI-may provide a more complete look at the injured elbow. It is unusual, but not unheard of, for these tests to be done in the emergency department.
  • Laboratory tests generally aren't needed for people with broken elbows. If you are taking certain medications, have certain health conditions, or require an operation to repair your broken elbow, then, lab tests may be done.
  • If your 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.

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Broken Elbow Treatment Self-Care at Home

Seek medical attention if you think you have broken your elbow. There is no home care. While seeking medical attention, however, here are some first aid tips that are important to remember:

  • If you have an open wound, cover it with a clean bandage. If you are bleeding, apply firm pressure and raise your arm.
  • Apply an ice pack or cool compress to the swollen area.
  • Call for emergency help or get someone to call for emergency help immediately.
  • If emergency help is not available immediately, or if you are transporting a person with a suspected broken elbow, immobilize 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 person to do that.
  • 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.

Medical Treatment

Treatment of a broken elbow depends on the type of injury that you have suffered. Your treatment may be as simple as elevating your splinted arm, applying ice to any swollen areas, and taking pain relievers. Treatment can also include operations to repair bones, nerves, and blood vessels. Children and adults usually have different types of elbow injuries. They also heal in very different ways. For these reasons, different treatments are often used for adults and children with broken elbows.

Medications

  • A wide variety of pain relievers are available.
    • 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 can be given by injection or IV.
    • If your elbow is dislocated or broken and needs to be reset, medications also can be used to help this process.
    • These medications relieve pain extremely well and although they may cause sedation (sleepiness), they allow muscles to relax and help a great deal while the doctor works on the elbow.
    • After receiving these medications and having their elbow reset, many people awaken to find their elbow has been repaired and splinted.

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Surgery

Sometimes an operation to repair your broken elbow is the best choice. This is particularly true if you have an open, or compound (a fracture in multiple pieces), elbow injury.

    • An open elbow injury means that 1 or more of the bones at the elbow has come through the skin.
    • Not only does the bone need to be put in place, but it also needs to be thoroughly cleaned so infection does not occur. This is best done in an operating room.

Elbow injuries that damage nerves and blood vessels often need to be fixed in the operating room. Medical researchers have found that certain types of broken elbows heal better if they are repaired in the operating room. Your doctor will discuss the treatment options with you and help you make the best choice.

Other Therapy

  • If your elbow joint is filled with blood or other fluid, the joint can be drained in the emergency department.
    • 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 will be applied.
    • Doctors use splints after many different types of elbow injuries. Doctors usually make splints of plaster. They typically place splints on the back of your arm and do not completely encircle it with the splint material. Splints are designed to hold your elbow in one particular position.
    • Splints for broken elbows usually run from near your shoulder all the way to your hand. They prevent the elbow from bending or the hand from turning. Such motions may disturb a healing fracture or dislocation of the elbow.
    • The doctor may provide a sling so your heavy splinted arm can rest comfortably. Your doctor may ask you to remove the sling at home and elevate your arm above your 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 your 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 your elbow is broken or the elbow is out of joint, your 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 your elbow need to be reset, medications are available to relieve the pain and anxiety you may feel.

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Next Steps

Follow-up

It is extremely important to follow your doctor's medical advice exactly if you have a broken elbow. Once injured, the elbow is not a "forgiving" joint as it heals. To get the best possible result after you've broken your elbow, pay attention to the advice your doctor gives you. Keep all follow-up appointments with your doctor.

Following are some of the common things you may be told after your first visit for your broken elbow:

  • Use medications to reduce pain and swelling.
  • Elevate your arm to reduce pain and swelling.
  • Leave your splint or cast in place. Take care of your cast or splint.
  • Take antibiotics to treat infection, if prescribed, or to reduce the chance of getting an infection.
  • Return to the emergency department immediately if you notice any of the following:
    • Your hand is cold.
    • Your hand is pale or blue.
    • Your hand is numb, tingling, or "dead" feeling.
    • Your forearm hurts if you move your wrist, hand, or fingers.

Prevention

Most broken elbows stem from trauma-falls, sports injuries, motor vehicle crashes. The same common-sense things you would do ordinarily to prevent accidents will help prevent elbow injuries.

  • In automobiles
    • Obey the rules of the road and drive defensively.
    • Always wear your seat belts while driving and as a passenger.
    • Don't drink alcohol and drive.
    • Don't drive a vehicle if you've taken medicines or drugs that may make you sleepy.
    • Children always should be in proper child restraint devices.
    • Don't drive with your arm propped on the window or hanging out of the car window.
  • At home
    • Remove household items that may cause you to trip and fall. Some common tripping hazards are power cords, small rugs, and footstools.
    • Wipe up spills and deal with any slick floors that might cause a trip and fall.
    • Try to keep walks and driveways ice-free in winter.
  • While exercising or playing sports
    • Don't exercise, practice, or participate if you are overly fatigued. Injuries tend to happen when you are tired.
    • Don't continue an activity if you are having elbow pain.
    • Always wear proper protective gear while playing sports.

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Outlook

The elbow is a very complex joint. Sometimes it is not very "forgiving" after it is injured. That is, the joint may develop certain problems. The way your elbow heals after it is broken depends on your age and medical condition at the time of your injury as well as the type of injury you have.

Certain types of elbow injuries are associated with particular types of problems as they heal. Children tend to heal better than adults. It is important to realize that many broken elbows heal without any problems. Your doctor will be able to advise you as your elbow heals.

Following are some of the more common problems with broken elbows:

  • Infection: Open injuries-when one of the elbow bones comes through the skin-have a higher infection risk. Bacteria can then enter the bone or joint and cause an infection.
    • Doctors try to prevent infection by using sterile techniques in the operating room.
    • They also attempt to wash away bacteria on or near open injuries.
    • Antibiotics can be used to treat infections as well.
  • 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 a problem for adults rather than for children.
  • Nonunion: A broken bone that does not grow back together is called nonunion. This can happen with certain types of elbow fractures. 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. Most people think of arthritis as painful joints. After a severe injury, people can develop a type of arthritis that may make a joint painful and stiff. Sometimes this can become worse with cold weather or overuse.
  • Nerve damage: The 3 nerves that run through the elbow can be cut, compressed, 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 your skin. If this occurs, the hardware may need to be removed.
  • Blood vessel damage: A large artery runs very near your elbow joint to supply blood to the forearm, wrist, and hand. Certain elbow injures may cut or compress this artery. Sometimes resetting the broken elbow will relieve pressure on the artery. Sometimes you may need an operation.

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Synonyms and Keywords

fractured elbow, injured elbow, swollen elbow, elbow trauma, broken elbow

WebMD Medical Reference from eMedicineHealth Reviewed by Carol DerSarkissian on November 12, 2016

Sources

SOURCE:

Broken Elbow from eMedicineHealth

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