Elbow Fracture

Elbow Olecranon Diagram

The olecranon exists without much protection from muscles or soft tissues, so with direct trauma, it can easily break.

Treatment

Treatment for an olecranon fracture depends on the severity of the injury. Simple fracturs can be treated with a splint, worn until the bone heals. Most olecranon fractures, however, require surgery because pieces of bone move out of place at the time of injury. Dr. Stowell would need to surgically restore the anatomy of these elbow pieces and motion in the joint. In some cases, the bone breaks where the bone fragments stick out through the skin called an open fracture. This is serious because with the broken skin, infection in both the wound and the bone are more likely to occur. Immediate treatment is necessary to prevent infection. 

Dr. Stowell will perform a thorough physical examination asking about your medical history, general health, and symptoms. He will then examine your elbow to determine the extent of your injury. Dr. Stowell may:

• Check your skin for cuts, swelling, blistering, bruising.
• Feel around your elbow to determine other areas of tenderness.
• Check your pulse at the wrist to ensure good blood flow
• Check to see that you can move your fingers and wrist and check your sense of feeling
• Examine your shoulder, upper arm, forearm, wrist, and hand to ensure that you do not have any other injuries 

Dr. Stowell will order X-rays of your elbow to help diagnose your fracture. He may order X-rays of other parts of your arm, shoulder, and wrist to determine whether you have other injuries. He will apply a splint (like a cast) to your elbow and give you a sling to help stabilize your elbow. Immediate treatment may include applying ice to reduce pain and swelling as well as medications for pain relief. Dr. Stowell will determine whether your fracture requires surgery.

Nonsurgical Treatment

If the pieces of bone are not displaced, a simple elbow fracture can be treated with a splint to hold the elbow in place while it heals. During the healing process, Dr. Stowell will order X-rays to monitor the bones placement and make sure it is healing in alignment. Typically, a sling is worn for about 6 weeks while starting gentle motion. If the fracture shifts during this time, Dr. Stowell may need to perform surgery to put the bones back together.

Surgical Treatment

Olecranon factures that fall into these two categories usually need surgery:

• Bones have moved out of place also called a displaced fracture
• Pieces of bone have punctured the skin also called an open fracture

During surgery of olecranon fractures, Dr. Stowell puts the broken pieces of bone back into position so that they can heal properly in place. Open fractures are scheduled for surgery immediately due to the risk of infection. Patients are given intravenous antibiotics and may even receive a tetanus shot. Surgery is performed usually within hours of the diagnosis. Dr. Stowell will thoroughly clean the cuts from the injury and the surfaces of the broken bone, and repair the bone all in the same surgery. 

Multiple surgical procedures exist to treat olecranon fractures:

• Open reduction and internal fixation – During this most commonly used procedure, Dr. Stowell first repositions (reduces) the bone fragment into their normal alignment. He uses screws, wires, pins, or metal plates attached to the outside of the bone to hold the pieces of bone in place.
• Bone graft – If some of the bone has been lost, the fracture may require bone graft to fill the gaps. Sometimes, an artificial material can be used instead of bone graft that is taken from a donor or from another bone in your body.

Surgical Complications

There are risks associated with any surgery. If Dr. Stowell has recommended surgery as the best treatment option for you, he believes the possible benefits outweigh the risks. Potential complications include:

• Elbow stiffness
• Infection
• Hardware irritation – when metal implants are used to repair fractures, a small percentage of patients may experience irritation
• Damage to nerve and blood vessels
• Nonunion – sometimes, a fracture does not heal. Screws, plates, or wires may shift or break. This can occur due to the following reasons:
  • Patient does not follow directions after surgery
  • Patient’s medical history, such as diabetes, slows healing process.
  • Extent of the open fracture can slow healing
  • Infection can slow or prevent healing 

In cases where a fracture fails to heal, you may need further surgery.

Recovery

Most fractures have moderate pain for a few days to a couple of weeks. Most patients tolerate the pain by using ice, elevating their arm, and taking non-prescription pain medication. If pain is severe, consult with Dr. Stowell for prescription-strength medication for a few days. For reasons of opioid dependency, it is important to use opioids for a short amount of time and to stop taking them as soon as your pain improves.

Rehabilitation

Surgical or nonsurgical treatment requires a diligent rehabilitation effort from you. Stiffness may occur with nonsurgical treatment due to the longer length of time your elbow is stabilized in a splint or cast. A longer physical therapy plan may be necessary to regain motion. Your unique physical therapy program should help improve your range of motion, decrease stiffness, and strengthen the muscles within the elbow. Adhere to specific restrictions of lifting, pushing, and pulling with your injured arm for a few weeks. Once you start physical therapy, be sure to do your exercises regularly because that will make the biggest difference in your progress. 

After surgery, you will not be allowed to lift heavy objects for at least 6 weeks. You will be restricted from pulling or pushing, but may be allowed to use your injured arm for bathing, dressing, and feeding. Dr. Stowell will give you specific instructions. 

Even with successful treatment, some patients may experience long-term loss of motion and posttraumatic arthritis in their affected elbow. Fortunately, even with the loss of a few degrees of straightening or extending, it does not usually affect the overall function of the arm. Further surgery, intensive physical therapy, or special bracing may be necessary for those patients experiencing significant loss of motion, although uncommon for olecranon fractures. 

After an injury, arthritis in the affected area commonly develops. It can occur shortly after or years after the injury. Some patients need further surgery down the road to help relieve symptoms; however, for many, there is little pain and no need for further treatment. 

Full healing is slow and can take up to a full year. Most patients return to their normal activities within about 4 months. An X-ray may show that the fracture is completely healed, but your elbow may still show limitations in movement. Over time, the movement generally improves.