Elbow Fractures

Overview

four patterns, one shared rule

The elbow is a hinge built from three bones. The distal humerus is the flared lower end of the arm bone. The olecranon is the bony point of the elbow, at the top of the ulna. The radial head is the top of the radius; it spins when you turn your palm up and down. Add the coronoid, a bony shelf on the ulna that keeps the elbow from dislocating forward, and you have four fracture patterns that look and behave quite differently from each other.

The way you got hurt narrows the list fast. A fall onto an outstretched hand in a younger person is a radial head fracture until proven otherwise. A direct fall onto the point of the elbow is an olecranon fracture. A high-energy injury raises the possibility of a coronoid fracture or a distal humerus fracture. That means a car crash, a fall from height, or an elbow dislocation that popped back in on its own. Coronoid fractures almost never happen alone. They travel with ligament injuries and radial head fractures in the terrible triad.

What makes elbow fractures stand out among arm injuries is the stiffness penalty. The elbow does not tolerate being kept still. Even a well-healing fracture that sits in a cast or splint too long can permanently lose some of its ability to straighten. The treatment plan for nearly every elbow fracture, with surgery or without, is built around getting motion back early.

Each of these patterns has its own page with the mechanism, diagnosis, and treatment specific to it:

What It Feels Like

how each pattern shows up

The classic presentation is an elbow that swelled quickly after an injury and will not straighten or bend fully. With a radial head fracture, the hallmark is pain when you try to rotate your forearm (turning a doorknob, using a screwdriver). With an olecranon fracture, you can feel the gap at the back of the elbow and you have lost the ability to straighten the arm against gravity. With a distal humerus fracture, the whole elbow is swollen and tender. You will hold the arm completely still, because any movement is severely painful.

There are three red flags. Numbness or tingling in the ring and small fingers: the ulnar nerve runs right behind the elbow and gets stretched or trapped in fractures. Inability to extend the wrist or fingers: that points to the radial nerve. And significant swelling in the forearm with pain when someone else gently straightens your fingers: that can signal compartment syndrome, rare but an emergency.

How We Make the Diagnosis

imaging that pins down the pattern

Standard elbow X-rays, one from the front and one from the side, identify most fractures. Sometimes the X-ray shows signs of blood in the joint, which points to a fracture even when the break itself is hard to see. When the fracture pattern is complex, a CT scan is the next step.

How We Treat It

when a sling is enough

Radial head fractures that have not shifted, or have shifted very little, are the most common elbow fracture treated without surgery. The plan: a brief period of splinting for comfort (days, not weeks), then early motion. The guiding principle is that an elbow that does not move gets stiff. A stiff elbow is harder to get moving again than the fracture was to treat.

When Surgery Is on the Table

when the pattern forces an operation

Surgery is offered when the fracture is displaced enough that it will block motion or compromise stability if left alone:

Radial head fracture, displaced. Fixed with small screws or a plate when the pieces can be put back together (ORIF, open reduction and internal fixation). The radial head is replaced when they cannot. More on radial head fixation →
Coronoid fracture. Fixed as part of the larger instability pattern, usually a terrible triad. The coronoid is the keystone that keeps the elbow stable at the front.

If non-operative care is not enough, these procedures are offered by the OSI team:

Providers Who Treat Elbow Fractures

Michael S. Vrana, M.D.

David B. Templin, M.D.

Trent Twitero, M.D.

Frequently Asked

questions we hear in clinic

How do you tell which elbow fracture I have?

The way you got hurt narrows the list fast. A fall onto an outstretched hand in a younger person points to a radial head fracture. A direct fall onto the point of the elbow points to an olecranon fracture. A high-energy injury, such as a car crash, a fall from height, or an elbow dislocation that popped back in on its own, raises the possibility of a coronoid or distal humerus fracture. Standard elbow X-rays confirm most of them. A CT scan is added when the pattern is complex.

Will I need surgery, or just a sling?

It depends on the pattern. Surgery is offered when the fracture is displaced enough that it would block motion or compromise stability if left alone. Radial head fractures that have not shifted, or have shifted very little, are the most common elbow fracture treated without surgery. The plan is a brief period of splinting for comfort, days rather than weeks, then early motion.

Why is moving the elbow early so important?

What makes elbow fractures stand out among arm injuries is the stiffness penalty. The elbow does not tolerate being kept still. Even a well-healing fracture that sits in a cast or splint too long can permanently lose some of its ability to straighten. So the treatment plan for nearly every elbow fracture, with surgery or without, is built around getting motion back early.

What is the “terrible triad”?

Coronoid fractures almost never happen alone. They travel with ligament injuries and radial head fractures in a pattern called the terrible triad. The coronoid is the keystone that keeps the elbow stable at the front. So it is usually fixed as part of that larger pattern rather than on its own.

Are there warning signs I should mention right away?

Yes. Tell the team about numbness or tingling in the ring and small fingers; the ulnar nerve runs right behind the elbow and can be stretched or trapped in fractures. Tell them if you cannot extend the wrist or fingers, which involves the radial nerve. And tell them about significant swelling in the forearm with pain when someone else gently straightens your fingers. That can signal compartment syndrome, a rare but urgent problem.