Fracture

Radial Head Fractures

What is a Radial Head fracture?

The elbow has 2 main parts: the ulnohumeral joint and the radio-capitellar joint. It is made up of the articulation between the capitellum and the radial head. The function of the radial head is to transfer load across the joint and provide stability (valgus and longditudinal).

The radial head is usually injured as a result of a fall onto the outstretched hand.  It is more common in younger adults and may also be seen in children.  1 in 3 people have associated injuries of other bones and soft tissue elements.

A radial head fracture will typically cause pain at the lateral aspect of the elbow.  Rotating the hand from a palm up to a palm down position may be particularly difficult and painful.  The elbow often feels stiff and swollen.

How is the diagnosis made?

Sometimes the only sign of a fracture on the x-ray is bleeding into the joint:

Other times a fracture is more obvious. However a CT scan or an MRI scan may be required to characterize the severity of the fracture and what other structures are damaged.

What is the treatment?

Treatment depends on a number of factors including: patient age, occupation, severity of the fracture (number of fracture fragments), how far apart the pieces of the fracture are (displacement), whether elbow movement if blocked by a piece of bone (mechanical block) and associated injuries.

The vast majority of fractures which are in two parts, minimally displaced, do not cause a mechanical block ad have no associated injury can be treated conservatively. This involves pain-killers and early active movement supervised by a physiotherapist. The fracture will typically take six weeks to heal but many people find that they can move the elbow without pain before this time.

In some circumstances your surgeon may recommend an operation either to fix the bone, replace it with an artificial radial head or to excise fragments of bone.  In most cases the elbow will return to normal pain free function within three months of injury.

The most common ongoing problems are elbow stiffness, pain, osteoarthritis and rarely instability.

What are the risks of surgery?

The risks are low but include infection, bleeding, nerve injury, scar tenderness, stiffness, new pain at the elbow, recurrent instability, osteoarthritis and worsening of symptoms.

Olecranon Fractures

What is an olecranon fracture?

The elbow has 2 main parts: the ulnohumeral joint and the radio-capitellar joint. The former is made up of the articulation between the Trochlea and the Olecranon (tip of the elbow). It forms a hinge for flexion-extension of the elbow, contributes to elbow stability and is an insertion point for several important muscles.

Injuries are seen both in the young (high energy injuries) and the elderly (falls from standing height). They can occur via a direct blow or a fall onto an outstretched hand.

An olecranon fracture usually causes pain localised to the back of the elbow. There may be a defect felt at the back of the elbow. It causes weakness when trying to extend the arm, for example when trying to open a door.

How is the diagnosis made?

The fracture is usually seen on x-rays.

However a CT scan may be required to characterize the severity of the fracture and what other structures are damaged.

What is the treatment?

The vast majority of these fractures require surgery to restore function and strength to the elbow. This can be achieved by a variety of means.

Whilst on the whole outcomes are very good with early restoration of function and strength, up to 50% of patients require removal of hardware due to minor irritation.

A minority of fractures are treated conservatively in the elderly age group and they can achieve reasonable function.

What are the risks of surgery?

The risks are low but include infection, bleeding, nerve injury, scar tenderness, stiffness, new pain at the elbow, osteoarthritis and worsening of symptoms.

Distal Humerus Fractures

What is a distal humeral fracture?

The distal humerus consists of the elements that make up the top part of the elbow joint (capitellum, trochlea, medial and lateral epicondyles). They permit elbow flexion-extension, forearm rotation and provide attachment points for a number of important soft tissues (ligaments and muscles).

Injuries are seen both in the young (high energy injuries) and the elderly (falls from standing height). The position of the elbow at the time of impact will determine the fracture pattern. There are a number of different variations.

There will be gross elbow pain and swelling. It is imperative to check for damage to nerves and blood vessels, which traverse the elbow to get to the hand.

How is the diagnosis made?

Whilst x-rays will confirm the diagnosis, a CT scan is usually required to characterise the severity of the injury and make decisions about the type of surgery required.

What is the treatment?

Smaller fractures that are minimally displaced can be treated conservatively in plaster immobilisation followed by a course of physiotherapy. The majority of fractures however will require surgery. Some are amenable to fixing the elbow with plates and screws whereas others are so severely damaged that they require a half or whole joint replacement.

Movement is started immediately under the supervision of a physiotherapist. The majority of patients will regain 75% movement and strength within a year. 1 in 4 people have unsatisfactory outcomes due to a variety of factors relating to bone quality, fracture type and method of fixation. Some of these will require revision surgery.