How do they occur?
Elbow fractures may result from a fall, direct impact or forced elbow mobilization. Sprains, strains or dislocations can occur simultaneously with the fracture.
Elbow fractures include:
- Distal humerus fractures: usually occur in children and the elderly, and may be associated with neurovascular lesions; usually require surgical treatment with plaque and screws in the adult unless they are stable.
- Fractures of the head and neck of the radio: pain is usually worse with pronossupination (turning from the palm of the hand up and down); the treatment depends on the number and size of fragments as well as blockage or associated lesions, and may or may not require surgery, including fixation of the fragment (s), excision or arthroplasty (prosthesis).
- Fractures of the olecranon: are generally deviated, requiring the surgical treatment with metallic wires or plate and screws.
What are the signs and symptoms?
Pain, edema, flushing and stiffness may be signs of a possible fracture. There may be a cracking sensation upon injury as well as deformity, particularly if the fracture is associated with dislocation. The patient may experience paresthesias (tingling) or weakness of the forearm, wrist or hand.
How is the diagnosis made?
The radiographs associated with the clinical criteria may be sufficient for a definitive diagnosis, however, a computerized tomography may be necessary in the case of more complex fractures.
What are the therapeutic options?
Conservative treatment, such as the use of antebrachial suspension, splint or cast immobilization, is typically reserved for fractures where the risk of fracture deviation is low and the fragments are aligned. Age is also an important factor. Plaster immobilizations are more frequent in children because of the low risk of developing stiffness; however in adults the stiffness is much more common.
Fractures that deviate or are unstable usually require a surgical approach. In the case of open fractures (with cutaneous wound on the fracture) the surgery is urgent to cleanse the wound and bone and minimize the risk of infection.
What to expect from rehab?
The rehabilitation process, which includes physiotherapy, aims to maximize mobility and reduce the risk of rigidity. This can include exercises, scar massage, ultrasound, heat, ice and splints.