Traumatic injuries of the elbow include ligament tears, fractures, dislocations, and fracture-dislocations. These injuries can range from minor to severe depending on the ligaments involved, the bones involved, or both. There are three different bones of the elbow that can break or “fracture.” The most commonly broken bone of the elbow is the radial head which typically occurs from a fall onto an outstretched arm. Other fractured bones of the elbow include the olecranon (ulna) and the humerus which can be isolated breaks or a combination of breaks involving more than one bone. Dislocation of the elbow occurs when the joints of the elbow become separated and are no longer connected by the ligaments. Traumatic dislocations of the elbow are considered either simple or complex. Simple elbow dislocations are a pure dislocation of the joint resulting from disruption of the elbow ligaments without fracture or breaking of the bones. Complex elbow dislocations are associated with disruption of the ligaments in addition to fracture of one or more bones of the elbow (also known as a fracture-dislocation). Simple dislocations of the elbow are typically stable injuries once put back into place, whereas complex dislocations or fracture-dislocations of the elbow are generally unstable and can be associated with a shattered joint.
The types and patterns of injury to the bones and ligaments of the elbow are numerous ranging from minor to complex. But no matter the type of injury, one must understand that the elbow is an “unforgiving” joint when injured. Common problems that can develop after fractures or dislocations to the elbow are joint stiffness, joint instability, chronic pain, and post-traumatic arthritis. Even the simplest of fractures or non-displaced breaks of the elbow can lead to loss of elbow motion that can take months to restore. Evaluation by your elbow doctor in a timely manner is important to assess the degree of injury and to initiate the appropriate treatment to help avoid possible complications common to the elbow.
X-rays are needed to identify the fracture or to assess that the elbow joint is back in place after having a dislocation. A CT scan of the elbow may also be necessary for more complex fractures of the elbow. Depending upon the type of fracture pattern, location of the fracture, and findings on examination by your elbow specialist, treatment of the elbow injury will be determined. A minor elbow fracture is a break in the bone that has minimal fragmentation, minimal movement or shifting of bone out of position, maintains an overall good alignment, and remains stable. Most of these simple types of elbow fractures, such as a non-displaced or minimally displaced radial head fracture, can be treated with early motion and guided protection of the elbow as instructed by your elbow specialist. Simple elbow dislocations that are stable are also typically treated with an early range of motion protocol. Some fractures or dislocations of the elbow may require an initial period of protected immobilization followed by range of motion of the elbow. However, if the broken bone is unstable or shifts out of position, then surgery may be necessary to fix the fractured elbow (see example of fixed radial head fracture below).
Other more complex fractures or complex fracture-dislocations of the elbow are best treated with surgery to optimize functional outcomes. Fractures and fracture-dislocations of the elbow are typically fixed through an incision with screws or metal plates with screws (referred to as open reduction internal fixation). For more complex fracture or fracture-dislocation patterns of the elbow, a combination of internal fixation and partial joint replacement such as a radial head replacement may be necessary to stabilize the joint. In elderly patients who have osteoporosis, total elbow replacement may be the best method of treatment for complex elbow fractures. Typically following surgery, your physician will coordinate a therapy program with a Certified Hand Therapist to help facilitate and quicken the recovery process since elbow stiffness can be a difficult problem after injury.
Details of each type of elbow injury and type of treatment, whether managed with or without surgery, are discussed in detail by Dr. Katz with each patient.