WHAT YOU SHOULD KNOW
The function of the elbow is to position the hand in space. Any fracture of the elbow is a threat to this functional motion, since the elbow rapidly and easily becomes stiff following trauma. For this reason, elbow fractures must be dealt with swiftly and motion rehabilitation instituted as quickly as possible.
MEDICAL HISTORY
The circumstances of the trauma are very important since that determines the types of fracture and ligament injury expected. The overall amount energy transferred to the elbow translates directly into how stiff the elbow will become later. Falling onto the elbow from several stories off a building is a different injury than bumping the arm against the doorway. All the information about the patient’s lifestyle and work is important in setting treatment goals and selecting between different treatment options.
EXAMINATION
The degree of swelling, bruising, and deformity indicates the amount of energy associated with the injury. The elbow is examined for range of motion and stability if possible. In severe elbow fractures, it will be too painful to try this with the patient awake. It is important to check for nerve injuries associated with elbow trauma by performing functional tests in the hand.
ADDITIONAL TESTS
The main test needed to evaluate an elbow fracture is just a basic x-ray. Only in select cases of more complex fractures is there value to obtaining additional tests. A computed tomography (CT) scan is the preferred test to reveal the pattern of fracture fragments in 3 dimensions. This may assist in treatment planning if the regular x-rays failed to reveal certain information about the fracture pattern.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL FIXATION | PROSTHETIC REPLACEMENT | |
| CONSISTS OF | Early range of motion exercises | Joining together fracture fragments until they heal on their own | Replacing the fractured segment with a prosthetic implant |
| FEATURES | No added weight allowed | Uses screws only, or plates and screws as permanent implants | Metallic replica of just the radial head or the entire elbow |
| ADVANTAGES | Avoids surgery; Treatment of choice for stable radial head fractures | Provides stable fixation of fragments needed for early motion | Can solve a difficult case where fragment fixation would have been expected to fail during motion |
| DISADVANTAGES | Inadequate stability for almost all other elbow fracture patterns | Open incision surgery; Some possibility of displacement prior to bone healing or failure to heal at all | Man-made prostheses can loosen or wear out over time, especially with more aggressive use |
RECOVERY
No matter which of the three basic strategies is chosen, movement of the elbow must begin as soon as possible. Daily motion exercises are performed by the patient at home according to instructions given during outpatient therapy. Many hours each day must be devoted to these exercises if the patient expects to achieve a reasonable result. Some cases may require the use of specialized splints (static progressive splints) to achieve better motion after initial healing has occurred, rendering the limb stable. Outpatient therapy continues for at least 2 months, and home therapy for up to 6 months. If the elbow is still too stiff once the fracture has fully healed, the patient may need a capsulectomy procedure (see elbow contracture under medical conditions).
