The elbow joint is a joint of the upper limbs, formed between the arm bone (humerus) and the forearm bones (radius and ulna). The olecranon (upper end) of the ulna articulates with the humerus, allowing bending motions of the upper limbs at the elbow.
The radial head (upper end of radius) articulates with the humerus and the olecranon to allow supination and pronation (palm up and palm down) motions of the forearm.
As can be seen, the elbow joint is a very critical joint for the function of the upper limb. Damage to the joint will affect many aspects of a person’s life, including feeding, dressing, and hygiene. Unfortunately, the elbow joint is not covered by much soft tissue and lies very close to the skin.
This makes it vulnerable to injury. Injuries around the elbow can include fractures (broken bones) of any of the bones and/or dislocation (joint surfaces no longer in contact) of the ulno-humeral, or the radio-humeral articulations.
Fractures around the elbow include the following,
This article will focus on fractures of the olecranon process.
What are olecranon fractures and how do they occur?
The olecranon is the upper part of the ulna bone, and it articulates with the trochlea groove of the distal humerus to form part of the elbow joint. Olecranon fractures usually occur due to a fall onto the point of the elbow.
These fractures may also happen indirectly, when one falls onto their outstretched hand. In this case, the muscle attached to the olecranon, the triceps brachii contracts strongly, and breaks the olecranon, pulling it away from the rest of the ulna bone.
This second mechanism is especially prevalent in older patients who might have poorer bone stock.
The triceps brachii muscle is attached to the olecranon. When the bone is fractured, the triceps invariably will pull the broken part of the bone away from the rest of the ulna. This means that in most patients, the fracture ends will be a significant distance apart.
If the bone ends are too far away, the fracture will not heal properly, and in severe cases might not heal at all. If the fracture does not heal, elbow function may be severely affected, with weakness of arm straightening being the most disabling.
Generally after a fall, your doctor will begin by asking about the details of the fall, and the location and type of pain. He/she will then proceed to examine the elbow, looking especially for broken skin. The doctor may also evaluate your shoulder, upper arm and forearm/wrist, depending on the mechanism of injury.
Following the clinical examination, a plain X-ray of the elbow is frequently conducted, which will confirm the diagnosis of the fracture. In some patients with severe fractures, a computerised tomography (CT) scan may also be necessary to fully characterise the fracture.
After diagnosing the fracture, your doctor will often recommend placing the arm in an above elbow backslab with the arm held straight. Depending on the severity of the fracture, one of 2 treatment options may be offered,
Non-surgical treatment may be considered if the fracture is undisplaced. In this case, the arm is left in the backslab for a week, before a full above arm cast is applied. This cast is then worn for 3 to 4 weeks, before removal. Prior to removal of the cast, the fracture healing is typically evaluated with plain X-rays.
Surgical treatment is the preferred option if the bone ends are no longer in contact. The treatment of choice is open reduction and internal fixation, with the skin overlying the fracture ends cut to expose the broken bone within. This is then placed back into its original position, and the bone is then held with metal implants to allow bone healing in a good position. The skin overlying is then closed with sutures.
If surgery is deemed necessary, sutures will usually be removed 2 weeks after surgery, and an arm sling may be recommended for a week.
If the fracture was fixed surgically, elbow rehabilitation can begin once the pain subsides. In the case of fractures managed with casts, elbow rehabilitation begins after cast removal. In both cases, the focus is on restoring elbow range of motion. Later on, the focus may shift to increasing arm strength, especially with regards to bending and straightening motions of the elbow. In most patients, a period of 3-4 months of rehabilitation is sufficient.
For an assessment of your condition, please book an appointment with Dr. Yong Ren.
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