Elbow (Olecranon) Fracture

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The elbow joint (also known as the olecranon joint) is a synovial hinge joint, similar to the ankle and knee joints. Two or more bones form hinge joints that move along an axis, rather than rotate like the hip joint. The distal humerus and proximal ulna are the primary elbow joint bones. In addition, the hinge joint allows the elbow to bend and straighten. It also helps with hand motion by allowing the forearm to rotate.

The elbow consists of three articulations, which are:

  • The ulnohumeral joint.
  • The radioumeral joint.
  • The proximal radioulnar joint.

A fracture to a joint is a full or partial break in the continuity of bone tissue. Fractures can occur in any bone in the human body, such as the knee, arms, hands, and in these cases, the elbow. An elbow fracture is an injury that occurs from a break or crack in one or a combination of bones that make up the elbow joint. The main cause of an olecranon fracture is trauma, such as falling on the elbow or falling on an outstretched hand.

Generally, there are several types of elbow fractures, which include:

  • Extra-articular fractures – Extra-articular fractures are fractures that occur outside of the joint. These fractures can occur from blunt trauma or forcible blow to the end of the toes.
  • Intra-articular fractures – Intra-articular fractures occur where the fracture line crosses into the surface of a joint resulting in some degree of cartilage damage. The fractures can vary from hairline fractures to displaced fractures.
  • Radial head and neck fractures – Fractures in the had portion of the radius bone are referre3d to as radial head and neck fractures.
  • Distal humerus fractures – These fractures are common in children and the elderly. Nerves and arteries in the joint may sometimes be injured in these fractures.

Causes & Symptoms of Elbow (Olecranon) Fractures

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Elbow fractures are often the result of a fall on an outstretched hand, as mentioned earlier. Also, other causes can be linked to a direct impact to the elbow, or, in severe cases, a vehicle accident. Despite its causes, fractures, in general, are usually classified into three separate grades depending on the severity of the fracture:

  • Grade 1 elbow fracture – A first graded fracture involves small cracks which may not be visible in X-rays. The bone remains intact and no displacement occurs.
  • Grade 2 elbow fracture – A grade 2 may involve a slight displacement and a larger part of the bone may have been damaged.
  • Grade 3 elbow fracture – The bone is completely broken into multiple pieces and is largely displaced. Such injuries are serious and are accompanied by damage to the soft tissues as well as ligaments.

Normally, grade 1 and 2 fractures are treated without the need for surgery, however, grade 3 elbow fractures require further surgical treatment. Olecranon fractures can take 2-8 weeks or more to naturally heal, depending on their severity and on each affected patient’s overall health.

When a person notices a fracture on his or her elbow, there can be a number of symptoms that may accompany during or after the injury, such as:

  • Visible deformity – In some cases, a fractured olecranon is visibly deformed. This means that the elbow is dislocated or that bones are out of place.
  • Numbness or weakness in the arm, wrist, and hand – Once a fracture occurs, pain located around the affected joint may also feel painful to the touch, including a sign of weakness when using it.
  • Snap or popping sound – Experiencing an elbow fracture may cause the elbow to make a “popping” or “snapping” sound after it has been impacted.
  • Stiffness in and around the elbow – This can also cause a very limited range of movement when attempting to move the fractured elbow.
  • Swelling and bruising of the elbow – You may notice visible swelling and possible bruising on the elbow where the fracture was located in.
  • Extreme pain – Our joints are meant to stay in place at all times, however, once you fracture your elbow, an extreme amount of pain may occur after dislocating it.

Who gets an Elbow (Olecranon) Fracture?

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There are a number of ways that elbow fractures can develop, and some patients are at a higher risk of getting the condition than others. Therefore, here are some additional risk factors for olecranon fractures:

  • Age – People ages 30 and older are at an increased risk of developing elbow fractures. The risk escalates further after the age of 40 due to general wear and tear (degeneration).
  • Occupational laborers – Working in occupations that require climbing or machine operating can increase the risk of fracturing the elbow joint due to chances of falling and/or twisting movements.
  • Vehicle accidents – Driving and experiencing a collision afterward can put you at risk of fracturing not only your elbow but anywhere else in your body depending on the severity.
  • Sports – Some sports can increase the chances of fracturing or dislocating your olecranon joint during the event, such as rock climbing, skiing, skating, and American football.

How Does an Elbow Fracture Affect You? How Serious is it?

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In severe cases of an elbow fracture, there are small fragments of bone that prevent regular elbow movement or have the potential to cause longer-term problems with the injured elbow, which requires the need to be surgically removed.

Of course, all surgeries require incisions (cuts that allow surgeons to open an area of the body and make repairs). Therefore, this means there is a chance of complications to be present during the procedure, such as:

  • Persistent elbow pain – Some patients tend to continue to have persistent elbow pain after surgery.
  • Nerve or blood vessel damage – During surgery, there is a minimal chance that the nerves, veins, or tissue around your elbow can be damaged temporarily or permanently. Damaged nerves or blood vessels can cause numbness, pain, or lower blood flow around the elbow.
  • Blood clots – Because a rupture repair affects the way blood flows around your elbow, it can raise the chances of developing blood clots.

Recommended Treatment & Rehabilitation for an Elbow Fracture

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To receive a successful diagnosis of a fractured olecranon, your doctor will begin by carefully examining the injured area for tenderness, bruising, and swelling. One or more of the following imaging tests may also be ordered to get a clearer view of the fractured bone and to check for damage to muscles or blood vessels:

 

X-ray

This is the main tool used for diagnosing a fractured. An X-ray may help determine whether bones in the arm are either displaced or healing in the proper position.

Magnetic resonance imaging (MRI)

Some fractures do not appear on an X-ray until a few weeks after the bone begins to feel painful. An MRI is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the elbow.

Computed tomography (CT) scan

A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images, both horizontally and vertically, of the body.

After a diagnosis has been done, physiotherapy may be further advised. A physiotherapist will design a specific treatment program specific to your condition and goals. This will help improve your elbow movement and strength, ease swelling, and restore the use of your arm for daily living and athletic activities.

Therefore, while your bone heals, your arm will be in a cast or sling to help keep it stabilized and allow healing. This is also the case if you have had surgery. During the recovery phase, it is important to prevent as much stiffness, weakness, or swelling as possible.

Depending on the level of activity that is allowed by your physician for your type of fracture or surgery, your physiotherapist will prescribe the right exercises to keep your shoulder, wrist, and hand moving while you are in the cast or sling. He or she will then help you stay as independent as possible by teaching you how to perform your daily activities while wearing a cast or sling.

After your cast or sling is finally removed, your elbow will most likely be stiff and your arm will be weak. Therefore, your physiotherapist will examine your elbow and select specific treatments based on your physical problems, goals, level of physical activity, and overall health. Below are some treatments your therapist may guide you through:

 

Reduce pain and swelling

Your therapist may use different types of treatments and electrothermal modalities, such as specialized massage, electrical stimulation, and cold packs to reduce pain and swelling.

Improve your ability to move

Your physiotherapist will choose specific activities and treatments to help restore normal movement in the elbow and arm. These might begin with passive motions that your therapist performs for you to gently move your elbow joint, and progress to active exercises and stretches that you do yourself.

Increase your flexibility

Your therapist may gently apply hands-on treatment to enable your joints and muscles to move more freely with less pain. These techniques can include stretches and therapeutic massage techniques.

Increase your strength

If your physiotherapist finds any weakness in your arm or hand muscles, he/she will choose, and teach you, the best exercises and equipment to steadily restore your strength and agility. You might use equipment, such as therapy bands, therapy putty, and hand weights to help strengthen your affected arm.

Improve your endurance

Restoring your arm’s endurance is very important after an injury. Your therapist will develop a program of activities to help you regain the endurance you had before the injury, so you can return to doing the things that you like to do.

Return to your activities

Your therapist will discuss your activity goals with you and use them to set your work, sport, and home-life recovery goals.

Stretching

Stretching is a key to boosting your healing process. Stretching the elbow is important in both healing and prevention, and these exercises may be repeated at home multiple times a day in order to ensure mobility of the elbow. The following below are some useful exercises you can learn and perform either at home or elsewhere:

 

Elbow flexion

First, stand with your arm at your side. Then, actively bend your elbow up as far as possible, then grasp your forearm or wrist with your other hand and gently add overpressure. Hold the bent position of your elbow for 5-10 seconds, and then release the stretch by straightening your elbow. Repeat this exercise 10 times a day.

 

Elbow extension

Sit in a chair with your elbow resting on a table. You may want to rest your upper arm on a pillow or folded towel for comfort. Next, straighten your elbow out all the way, and then apply pressure to your forearm or wrist to add more pressure to the stretch. Straighten your elbow out as far as you can with overpressure, and hold the stretch for 5-10 seconds. Release the stretch and allow your elbow to bend a bit. Repeat this exercise for 2 sets of 10 repetitions a day.

 

Forearm supination

Begin by standing or sitting with your arm at your side and your elbow bent about 90 degrees. Next, keep your elbow at your side and turn your wrist and hand over so your palm faces up. To add more pressure to the stretch, use your opposite hand and reach underneath the forearm of your supinated arm. Grab your wrist and gently add pressure by turning your hand further into supination. When a stretch is felt, hold the position for 5-10 seconds. Repeat this elbow supination exercise with 2 sets of 10 repetitions a day.

 

Elbow pronation

Stand or sit with your elbow bent at a 90-degree angle and tucked in at your side. Turn your hand and wrist over as far as possible, then reach your other hand over the top of your forearm. Then, grab your wrist, and turn your arm further into a pronated position. Finally, hold the position with pressure for 5-10 seconds, and then release the stretch. Repeat this stretch with 2 sets of 10 repetitions a day.

Alternative & Homeopathic Treatment for an Elbow Fracture

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The following homeopathic treatments below are helpful in easing discomfort and encouraging healing after being treated for a fractured olecranon:

  • Rest – Resting your fractured elbow can help reduce its recovery time, allowing you to return to your activities sooner.
  • Non-steroidal anti-inflammatory medications (NSAIDs) – such as ibuprofen, naproxen, or acetaminophen, can all help relieve pain and reduce inflammation.
  • Ice and heat application – Placing an ice pack on your injured joint helps reduce inflammation and pain. Use a cold pack every 15-20 minutes at a time. After 2 or 3 days, when the pain and inflammation subsides, hot packs or a heating pad may help relax tightened and sore muscles.