Elbow Fractures Elbow Anatomy An elbow fracture is a break in one or more of the bones that make up the elbow joint. The bones in the elbow joint are: . Humerus: the upper arm bone. Ulna: the larger of the forearm (lower arm) bones. When you bend your elbow, you can easily feel its "tip," a bony prominence that extends from the ulna. That tip is called the olecranon. It is positioned directly under the skin of the elbow, without much protection from muscles or other soft tissues. It can easily break if you experience a direct blow to the elbow or fall on a bent elbow. Radius: the smaller bone in the forearm (lower arm). Causes An elbow fracture is caused by trauma to the elbow bone(s). Trauma can be caused by: . Falling on an outstretched arm . Falling directly on the elbow . Direct blow to the elbow . Twisting the elbow beyond the elbow's normal range of motion Risk Factors A risk factor is something that increases your chance of getting a disease, condition, or injury. Elbow fracture risk factors include: . Advanced age . Decreased muscle mass . Osteoporosis , due to menopause or other conditions . Participation in certain sports such as football, hockey, wrestling, and gymnastics Symptoms Symptoms include: . Pain, often severe . Tenderness, swelling, and bruising around the elbow . Numbness in fingers, hand, or forearm . Decreased range of motion . A lump or visible deformity over the fracture site Diagnosis It is important to see a physician and verify that there is no associated damage to nerves or blood vessels. Your physician will use x-rays to confirm the diagnosis and classify the type of fracture. Fractures are generally divided into three types, depending on the stability of the joint and the amount of separation among the broken pieces of bone. Elbow Fractures Treatment Treatment will depend on the severity of the injury. Treatment involves: . Putting the pieces of the bone back in position, which may require anesthesia and/or . surgery . Keeping the pieces together while the bone heals itself by using one of the following devices: o A cast or splint (may be used with or without surgery) o A metal plate with screws (requires surgery) o Screws alone (requires surgery) The doctor may prescribe pain medication depending on the level of pain. Your doctor will order more x-rays while the bone heals to ensure that the bones have not shifted position. Nonsurgical: A non-displaced fracture can usually be treated with a splint or sling to hold the elbow at a 90 degree angle. The physician will request a second set of x-rays after 10 to 14 days to make sure that the broken pieces have not become displaced. Gentle motion is permitted, and hand and wrist exercises should be done daily. Surgical: A displaced fracture is best treated surgically. The orthopedic surgeon will use a plate or a combination of wires and pins or screws to hold the bones in place. Physical therapy to maintain range of motion will start a day or two after the operation, and continue for at least six weeks. Fractures of the tip of the olecranon that do not involve the joint may be treated by removing the small fragment and repairing the tendon that has pulled off. Elderly people who experience an olecranon fracture may be treated with a sling and early range of motion instead of surgery. Athletes who have stress fractures of the olecranon are treated with activity restriction, stretching and range of motion exercises, and substitution activities for 8 to 12 weeks, although complete recovery may take three to six months. Exercise When your doctor decides you are ready, start elbow range-of-motion exercises and strengthening exercises for the shoulder and the entire arm. You may be referred to a physical therapist to assist you with these exercises. Do not return to sports activity until your elbow is fully healed and completely functional. Healing Time It takes about 8-10 weeks for a fractured elbow to heal. Pain Management Elbow Fractures We understand how much discomfort a broken elbow can cause. You will be given a prescription for one of the pain medications containing narcotics, such as Vicodin (hydrocodone/acetaminophen), Tylenol #3 or Percocet. Please follow the instructions. Try not to take these medications on an empty stomach. If you were instructed not to eat the night prior your surgery, take your medications with a small sip of water. Ask your doctor if it is OK for you to add ibuprofen (Motrin, Advil), Naprosyn (Aleve) or other arthritis medications for pain control. It is safe to combine this type of medicine with narcotics. DO NOT TAKE ARTHRITIS MEDICATIONS PRIOR TO YOUR SURGERY OR IF YOU HAVE A HISTORY OF STOMACH BLEEDING. (Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.) As the fracture heals, pain will subside and you will be able to decrease the amount of pain medication needed. Eventually you can discontinue narcotic medication and start taking acetaminophen, ibuprofen, or similar medication for pain control. Potential Problems Any injury around the elbow joint bears the risk of developing permanent problems. Stiffness and nerve injuries are among the most common and devastating complications of elbow injuries. Things to Do . Do not drive while taking narcotic pain medication. Do not smoke tobacco. Nicotine significantly decreases the process of bone healing and increases the risk of nonunion, a condition in which a break does not heal despite treatment. If you have been a smoker, maybe it is time to seriously consider quitting. Do not get your cast or brace wet. If you had surgery, do not get your incision wet until you have been instructed to do so. Do not bear weight on the side with the fracture until you have been instructed to do so. Things to Consider Fractures of any type increase your likelihood of developing arthritis in the affected joint; the more severe the fracture, the higher the risk of developing some degree of arthritis. Some patients experience discomfort in the area where the plates and the screws were inserted, even after the fracture has healed. If the discomfort persists for a long time, additional surgery can be done to remove the plates and screws. During the visit to your doctor, please let us know if you need any paperwork for a temporary disability. You will be given a VOT (verification of treatment). Please submit this form to our Business Office for completion of the paperwork. LINKS: American Academy of Orthopedic Surgeons: http://orthoinfo.aaos.org/menus/arm.cfm © 2011, The Permanente Medical Group, Inc. All rights reserved. Santa Clara Health Education. ######### (Revised 10-11) RL 10.0 .