Have you been diagnosed with an elbow fracture? Are you looking for information on this topic?
Based on my experience as a diagnostic radiographer and the scientific studies on this subject, I have written this article for you.
Happy reading!😀
Have any questions, remarks, or experience to share? Feel free to use the comments section at the end of the article!🙏
Last updated: March 2024. Written by Juliet Semakula, diagnostic radiographer.
Disclaimer: no affiliate links.
We shall start off with some bit of anatomy, Promise you a tiny bit!🙋
Anatomy
The elbow consists of portions of three bones and muscles:
1️⃣The distal humerus forms the upper part of the elbow and is the spool around which the forearm bends and straightens.
2️⃣The radial head is the knobby end of the radius where it meets the elbow. It glides up and down the front of the distal humerus when you bend your arm and rotates around the ulna when you turn your wrist up or down.
3️⃣ The olecranon is the part of the ulna that cups the lower end of the humerus, creating a hinge for elbow movement. The bony point of the olecranon can easily be felt beneath the skin because it is covered by just a thin layer of tissue.All bones surrounded by different muscles that help elbow movement.
That’s it with the anatomy lesson. Told you!💁
Elbow Anatomy
▶️What does an olecranon fracture look like?
Elbow olecranon fractures are very common in both adults and children.
Over the years of my experience, I have x-rayed so many elbow fractures. But the good news is, they can be treated, and you can be able to use your arm as before.
An olecranon is a break in the bony tip of the elbow as projected in images below. This pointy segment of bone is part of the ulna, one of the three bones that come together to form the elbow joint.
The olecranon is positioned directly under the skin of the elbow, without much protection from muscles or soft tissues. So, it is more likely to break easily if you experience a direct blow to the elbow or fall onto the tip of the elbow.
⚠️Caution⚠️! It is important to rule out other injuries about the elbow which may affect the treatment plan. The skin should be evaluated for open fractures.
Other common associated injuries include coronoid fractures, radial head, and neck fractures, radial head dislocation, and collateral ligament injury.
▶️Different types of olecranon elbow fractures
The different types are classified based on fracture comminution, displacement, and stability of the ulna-humerus joint.
Your fracture could be non-comminute or comminute respectively.
↪️Type I fractures are nondisplaced.
↪️Type II fractures are displaced at least 3mm, however, the ulna-humerus articulation is maintained indicating intact collateral ligaments.
↪️Type III injuries: the fracture is displaced, and the ulna-humerus joint is unstable. This injury is a fracture-dislocation, collateral ligaments may be incompetent causing instability.
Example of type III displaced ulna-humerus joint fracture are shown in image A above and B is an example of type I:
▶️Is an olecranon fracture serious?
Yes, olecranon fractures can be a serious fracture and most of the time if surgery is required, you may be taken to theatre someday. They are classified as urgent because they can sometimes be part of a more complex elbow injury.
The triceps muscle inserts onto the olecranon, blending with the periosteum. A displaced fracture interrupts the extensor mechanism resulting in loss of active elbow extension.
The pull from the triceps is the key deforming force, pulling the separated fragment superiorly.
Causing greater displacement suggests tearing of the fibrous sheath over the olecranon.
This can cause stability to the elbow joint, acting as a block to the anterior translation of the ulna in relation to the distal humerus.
Too many medical terms here, just know an olecranon fracture can be a serious fracture and when you think you have had one, please see your doctor as soon as possible.
▶️What are the symptoms of elbow fractures?
An olecranon fracture is usually hard to miss. The most common indications include:
🟢A fracture can be very painful and make elbow motion difficult or impossible.
🟢Typically elbow pain, sometimes deformity and swelling following a fall will be visible.
🟢Numbness in the hand, a sign of potential nerve injury
🟢Inability to straighten the arm in some cases.
Examinations
Your doctor will send you to have an x-ray to determine if you have had a fracture. Usually, x-rays are sufficient to determine if you have had a fracture.
A CT scan will only be requested if your fracture is complex, meaning with associated injuries for pre-operative planning.
▶️What is the Treatment for an olecranon elbow fracture?
Treatment for an olecranon fracture will depend on how critical your injury is.
Conservative method:
If your fracture is nondisplaced it will be treated with an initial period of immobilisation in a posterior slab long arm splint with the elbow in 45-90 degrees of flexion.
Splints provide less support than casts: However, you can easily adjust it to accommodate swelling from the injury.
In many cases, a splint is applied to a fresh injury first. As swelling subsides, a full cast may replace the splint.
Surgery option
If your fracture is type II and III injury generally you may require surgical intervention. Usually in these types of fracture the pieces of bone move out of place when the injury occurs.
For these fractures, surgery is required to restore both the normal anatomy of the elbow and motion in the joint.
Based on your injury closed reduction /percutaneous pinning or open and internal fixation may be used to treat your injury.
Percutaneous pinning, the displaced bone fragments are repositioned during closed reduction and held in place with metal pins. The pins are inserted through the skin, into the bone and across the fracture. A splint is applied to protect the area for the first week, then is typically replaced with a cast.
The pins and cast are removed after healing has begun, a few weeks after surgery.
An example of a closed reduction where the fracture fragments are held in place with metal pins.
This x-ray shows a supracondylar humerus fracture that has been put into the correct position and held in place with two pins. The pins will be removed after healing has begun.
Open reduction and internal fixation.
Open fractures, cannot be repositioned during a closed reduction, and fractures that are accompanied by nerve or vascular injuries require open surgery or open reduction and internal fixation.
Plate and screw fixation is recommended for unstable fracture patterns with significant comminution or a fracture line exiting distal to the semilunar notch and fracture dislocations.
Image Plate and screw fixation
Although outcomes after surgery are relatively good, it is not uncommon for patients to have a range of motion (ROM) deficit or require a repeat procedure to remove hardware. (Sullivan,2023)
The elbow will be wrapped in a padded bandage after surgery. The bandage is usually removed after 24-48 hours and replaced with an elastic support (tub grip).
If ligaments were repaired, the elbow may be protected in a brace.
Prior to your discharge from hospital a physiotherapist will provide you with instructions about looking after your elbow.
It is important to keep the elbow elevated for at least 7-10 days after surgery to avoid swelling.
▶️Surgery benefits and possible complications
Surgery allows the displaced bone fragments to be realigned and fixed in a way that restores and maintains the shape of the bone. This in turn allows an earlier and better recovery of function.
An appointment will be arranged for you to be seen in 2 weeks after the procedure.
Follow-up may be required for at least 6-12 months after surgery or until a satisfactory recovery is achieved.
X-rays will be performed at intervals to monitor your fracture healing.
➡️Possible complications after surgery:
🟤Some patients have complained of soft tissue Irritation of tension-band wire which sometimes require hardware removal.
🟤 Sometimes your Wound could get Infection due to the nature of the olecranon which is surrounded with little soft tissue coverage over the used fixation.
🟤 Non-union occasionally the fracture may fail to heal however, the risk of non-union is approximately 1% (Baecher,2013)
🟤 Or Malunion sometimes the bone may heal in an abnormal position. In some instances, the elbow may continue to function well despite a malunion but if function is affected then further surgery may be considered.
🟤Pins that are too long can restrict supination by impinging on the radial neck or damaging the biceps tendon or supinator muscle.
🟤Bleeding may occur during or after surgery.
🟤Loss of Motion /elbow stiffness some degree of stiffness is not uncommon following injury and surgery.it will resolve as you start moving the elbow with the aid of physiotherapy.
🟤Plate fixation failure: If the bone is weak due to osteoporosis or fragmented, the plate and screws may not hold well, and the fixation may fail.
If you find yourself having some of the complications, consult a professional to ensure that your fracture is not heading the wrong path.
⚠️Caution⚠️!From a healing perspective, most elbow fractures heal well with proper care so you should not focus on the possible complications but on your healing and quick recovery.
▶️How long does it take for a fractured elbow (olecranon) to heal?
Whether you have undergone surgery or not you will likely have a period of immobilisation. ‘However, this immobilisation is relative, meaning it is shorter and less dependent.
✅on the treatment implemented.
✅Individual constitution: we are not all equal in terms of how quickly our bones heal.
💁The Goods News is ! Fracture stability and wound healing will depend on your compliance! Assuming you’ve done everything right in terms of treatment and rehabilitation plan will help with quick recovery.
Here is a rough idea!
Staying healthy can help you recover from your injury faster. Try to eat well, stay hydrated and keep active as much as possible.
Medical evidence suggests that smoking prolongs fracture healing time, so, if you are a smoker, stop smoking during the healing phase of your fracture.
The rehabilitation plan is outlined in the table below. (NHS guidelines)
| Weeks since injury | Rehabilitation plan |
| 0 to 2 weeks | 🟠Wear the sling for comfort only. Remove when completing exercise |
| 2 to 4 weeks | 🟠Discontinue using the sling. 🟠Begin normal light activities using your arm 🟠Avoiding lifting more than the weight of a cup tea for 6 weeks 🟠Continue with exercise |
| 6 to 12 weeks | 🟠Fracture should be united (healed). 🟠Gradually resume normal activities as pain allows. 🟠Heavier or more difficult tasks may still be hard and cause discomfort at this stage. 🟠Symptoms will continue to improve over the next few months |
⚠️Caution⚠️! If you feel pain after 12 weeks of treatment please always consult your doctor.
➡️What type of splint to wear
Your doctor will be able to tell you what kind of sling to wear. The sling should be able to give you comfort when you wear it.
You can stop using the sling as soon as you feel comfortable to do so. You can take it off to wash, dress and exercise.
➡️Can you move your elbow with an olecranon fracture?
Olecranon fractures are known to stiffen your elbow quickly, so it is important to start the simple exercises as soon as your cast is taken off.
🙆DON’TS
Do not drive with a sling, make sure your elbow has healed well, and you can safely move the car without causing accidents. Some studies advise driving after 4 to 6 weeks but this will depend on your country’s driving regulations.
▶️Broken elbow simple exercises with or without the help of physical therapy.
Simple elbow exercises you can try at home. NHS guidelines:
⏩Sit or stand with your elbow supported. Keep your elbow by your side during the exercise! Turn your palm up and then palm down.
⏩Bend and straighten your elbow so that you feel a mild to moderate stretch. Bend your elbow to 90 degrees Slowly turn your palm up and down until you feel a mild to moderate stretch. Do not push into pain.
⏩Lie on your back! Raise your injured arm so that your elbow points to the ceiling! Support your elbow with your other hand! Slowly straighten your arm to lift the hand in the air. Gradually lower your hand back down to the pillow.
This is what I wanted to tell you about elbow fractures. I hope I have given you some reassurance, I wish you a quick recovery.🙋
Below are some of the articles I have relied on for this article.
📚Sources:
Sullivan CW, Herron T, Hayat Z. Olecranon Fracture. 2023 Aug 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30725980.
Zeman P, Zeman J, Matejka J, Koudela K. Strednedobé zkusenosti s lécbou zlomenin patní kosti otevrenou repozicí a vnitrní fixací kalkaneární LCP z rozsíreného laterálního prístupu [Long-term results of calcaneal fracture treatment by open reduction and internal fixation using a calcaneal locking compression plate from an extended lateral approach]. Acta Chir Orthop Traumatol Cech. 2008 Dec;75(6):457-64. Czech. PMID: 19150004.
Duckworth AD, Clement ND, White TO, Court-Brown CM, McQueen MM. Plate Versus Tension-Band Wire Fixation for Olecranon Fractures: A Prospective Randomized Trial. J Bone Joint Surg Am. 2017 Aug 02;99(15):1261-1273. [PubMed] [Reference list]
Baecher N, Edwards S. Olecranon fractures. J Hand Surg Am. 2013 Mar;38(3):593-604. [PubMed] [Reference list]
https://www.armdocs.com/treatment/operative-fixation-for-olecranon-fracture