A fractured elbow occurs when one or more of the three bones that meet at the joint—the humerus, the ulna, and the radius—suffer a break. Whether a cast is necessary depends entirely on the specific type and severity of the fracture. Elbow fractures range from small, stable cracks to complex injuries requiring surgical reconstruction. Treatment aims to restore the joint’s function and stability, which often requires immobilization but not always a traditional cast.
Classifying Elbow Fractures: Why Treatment Varies
The appropriate treatment relies heavily on how the orthopedic surgeon classifies the elbow fracture. Fractures are initially categorized based on displacement, which is whether the bone pieces have moved relative to each other. A non-displaced fracture means the bone is cracked but remains in proper alignment. A displaced fracture indicates the fragments have shifted out of position.
Stability is another variable, differentiating between stable fractures, where the pieces are unlikely to move, and unstable fractures, where bone fragments could shift after initial treatment. The specific bone involved is also a factor, such as breaks in the radial head, the olecranon (the bony tip of the elbow), or the distal humerus. An open fracture, where the bone has broken through the skin, carries a higher risk of infection and immediately alters the treatment plan. Non-displaced, stable fractures are the most likely candidates for non-surgical management.
Immobilization Techniques for Stable Fractures
For non-displaced or minimally displaced fractures, the primary treatment involves non-surgical immobilization, often starting with a splint rather than a full cast. A splint provides partial coverage and allows for swelling to occur without constricting the limb. This partial coverage is important because a full cast applied too early could lead to pressure issues as the elbow swells.
The purpose of initial immobilization is to manage pain and ensure the fracture site remains stable for healing. A common method is a posterior long arm splint, typically holding the elbow between 60 and 90 degrees of flexion. For many stable fractures, this rigid immobilization is maintained for only one to three weeks. Once swelling subsides, the splint may be replaced by a removable brace to allow for the early introduction of controlled movement.
The shift away from prolonged rigid casting is intentional because the elbow joint is susceptible to developing stiffness after extended immobility. Transitioning to a brace balances the need for fracture protection with the necessity of beginning gentle, protected range-of-motion exercises. This approach helps prevent the formation of joint contractures and scar tissue that can limit future elbow movement. The total duration of immobilization is determined by follow-up X-rays confirming adequate bone healing.
When Surgical Intervention is Necessary
A cast or splint is not sufficient when a fracture is highly unstable, significantly displaced, or involves the joint surface in a complex way. Highly displaced fractures require surgery to realign the pieces and restore the joint’s natural anatomy. Unstable fractures, where the bones cannot be held in place with external immobilization, need internal support to prevent them from shifting during the healing process.
Fractures that involve the joint surface, known as intra-articular fractures, often necessitate surgery to ensure the smooth cartilage surface is perfectly restored. Any slight step-off or misalignment in the joint can lead to post-traumatic arthritis and chronic pain. The most common surgical procedure for these complex injuries is Open Reduction and Internal Fixation (ORIF). This technique involves an incision to directly visualize and reposition the bone fragments, which are then secured using specialized metal implants like screws, plates, or wires. This internal hardware stabilizes the fracture, allowing for early, controlled motion to begin sooner than with a cast.
The Recovery Process and Managing Stiffness
Following either non-surgical immobilization or surgical fixation, the recovery phase centers on regaining the elbow’s full function, which is frequently challenged by joint stiffness. The elbow is particularly prone to developing limited range of motion because of scar tissue and adhesions forming around the joint during healing. Achieving long-term functional recovery depends significantly on a consistent and professionally guided rehabilitation program.
Physical therapy and occupational therapy are introduced early to combat this stiffness, sometimes beginning within the first few days after surgery or immediately after cast removal. Therapists guide the patient through a regimen of gentle, progressive range-of-motion exercises to stretch the surrounding tissues and restore the full arc of movement. Patients are typically advised to avoid lifting anything heavier than a cup of tea for about six weeks to protect the healing bone.
Full strength recovery and a return to unrestricted physical activity can take anywhere from four months up to a year or more, depending on the severity of the initial injury. A possible complication during this phase is heterotopic ossification, which is the abnormal growth of bone in the soft tissues, a condition that can further restrict motion.