A broken elbow, or elbow fracture, involves one or more of the three bones that form the elbow joint: the humerus (upper arm bone), the ulna, and the radius (forearm bones). The complex structure of the elbow allows for bending, straightening, and forearm rotation, meaning a fracture can significantly impair arm function. Treatment for this injury is not standardized; it depends entirely on the type and severity of the break, specifically whether the bone fragments remain aligned or have shifted.
Initial Assessment and Diagnosis
A thorough physical examination is the immediate focus to assess the injury and identify urgent complications. The healthcare provider checks the skin for open wounds, which may indicate a severe, open fracture where the bone has broken through the skin. A critical part of the exam involves checking the neurovascular status by assessing the pulse at the wrist and testing sensation and movement in the fingers. This ensures the fractured bones are not damaging nearby nerves and blood vessels.
Imaging is essential to accurately classify the fracture and determine the location and extent of the break. Standard X-rays are the primary tool, showing the bone structure and whether the fracture is simple, comminuted (broken into multiple pieces), or displaced (out of alignment). For complex fractures or those involving the joint surface, a Computed Tomography (CT) scan is often ordered. The CT scan provides a detailed, cross-sectional view helpful for surgical planning.
Managing Fractures Without Surgery
Non-operative management is the preferred course of action for stable fractures that are non-displaced or only minimally displaced. These fractures are in a good position to heal naturally without surgical realignment. The primary goal of this treatment is to immobilize the joint to allow the bone to heal while managing pain and swelling.
Immobilization is achieved using devices like slings, splints, or long arm casts, depending on the fracture’s location and stability. For non-displaced fractures, immobilization in a cast may last approximately three to six weeks. Pain is typically managed with over-the-counter or prescription anti-inflammatory medications during this phase. Follow-up X-rays are scheduled regularly to confirm that the bone fragments have not shifted out of alignment, which would necessitate surgical intervention.
Surgical Repair Procedures
Surgery becomes necessary when the fracture is severely displaced, is unstable, involves a joint-surface disruption, or is an open fracture. The overarching goal of any surgical procedure is to restore the normal anatomy of the elbow joint and provide enough stability to allow for early motion, which helps prevent stiffness. The most common procedure is Open Reduction and Internal Fixation (ORIF), where the surgeon makes an incision to manually realign the broken bone fragments (open reduction).
Once the bones are correctly positioned, metal hardware such as screws, plates, and wires are used for internal fixation, holding the fragments securely in place while the bone heals. For certain complex fractures, such as those involving the radial head that are irreparable, the surgeon may opt for a joint replacement, known as arthroplasty. In this procedure, the damaged joint part is removed and replaced with an artificial component, often considered for older patients when ORIF is unlikely to yield a functional outcome.
The Rehabilitation Process
Regardless of whether the elbow fracture was treated with or without surgery, the rehabilitation phase is a fundamental and lengthy part of the recovery process. The elbow joint is particularly susceptible to becoming stiff after an injury or a period of immobilization, making the restoration of range of motion a primary focus. Physical therapy (PT) is typically initiated early, sometimes within one to two weeks after surgery or following the initial immobilization period.
The first exercises are gentle, active range of motion movements where the patient moves the arm without assistance, carefully protecting the healing bone. As healing progresses, typically around six to ten weeks, the physical therapist introduces strengthening exercises and progressive passive range of motion. Patients usually return to light daily activities within three to five months, though regaining full strength can take up to a year. The timeline for returning to activities like driving or lifting significant weight is determined by the surgeon and physical therapist based on X-ray evidence of bone healing and the patient’s functional progress.