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INDEX

    Elbow Fractures

    Orthopedic, Trauma

    Last Updated Jun 17, 2023
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    By Joe Finkler, Allie Cui

    First 5 Minutes

    • Assess the neurovascular status of the injured extremity. Check for changes in sensation, motor function and pulses distal to the fracture site.
    • Look for evidence of obvious deformities or compound fracture.

    Context

    Figure 1 (Left): Anterior view of the elbow joint. https://commons.wikimedia.org/wiki/File:202107_Anterior_view_of_the_elbow_joint.svg. Image adapted from Wikimedia Commons. Figure 2 (Right): Posterior view of the elbow joint. https://commons.wikimedia.org/wiki/File:202107_Posterior_view_of_the_elbow_joint.svg. Image adapted from Wikimedia Commons.

    • The elbow is a synovial hinge joint that connects the humerus to the ulna and radius, and is stabilized by 4 major ligaments.

    Diagnostic Process

    • Conduct a complete neurovascular examination of the injured extremity.
    • Assess for open fracture.
    • Examine the joint above and below the suspected area of injury as pain can radiate.
    • Integrity of the supporting ligaments may be tested via the varus and valgus stress tests, however, limiting movement is recommended if fracture is suspected.

    Imaging:

    • The elbow extension test can be used to guide the decision to order radiography — patients who can fully extend their elbow have a low chance of fracture.

    Types of fractures commonly seen:

    • Radial head fracture.
    • Olecranon fracture.
    • Coronoid fracture.
    • Monteggia fracture-dislocation (uncommon but often mentioned).

    Recommended Treatment

    Orthopedic referral is recommended for all but radial head fractures that do not impair supination/pronation.

    Non-operative Management:

    • Conservative management is indicated for non-displaced fractures.
    • Most patients will recover via immobilization by a cast or splint.
      • Long arm cast: Used for severe or unstable elbow fractures that require rigid immobilization.
      • Long arm posterior splint:

    Created by Ella Barrett-Chan, MSI UBC 2023

    Criteria For Hospital Admission

    Hospital admission should be considered for patients with:

    • Open, displaced or complex fractures, or
    • Vascular or neurological compromise.

    Criteria For Transfer To Another Facility

    Consider transferring patients to another facility if:

    • The patient has a severe elbow fracture that requires specialized care that is not available at the current facility.

    Quality Of Evidence?

    Justification

    Moderate

    Related Information

    Reference List

    1. Boyd AS, Benjamin HJ, Asplund C. Splints and Casts: Indications and Methods. afp. 2009 Sep 1;80(5):491–9.


    2. Walthall J, Adame JD, Varacallo M. Long Arm Splinting. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 May 19]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK513283/


    3. Appelboam A, Reuben AD, Benger JR, Beech F, Dutson J, Haig S, et al. Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children. BMJ. 2008 Dec 9;337:a2428.


    4. Goldflam K. Evaluation and Treatment of the Elbow and Forearm Injuries in the Emergency Department. Emergency Medicine Clinics of North America. 2015 May 1;33(2):409–21.


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