Elbow fracture

What is an elbow fracture?

An elbow fracture is a crack or break in the humerus, ulna, or radius—the three bones that make up the elbow. It often occurs after a fall or a blow, the same mechanism that can also cause an elbow dislocation, in which the bone pops out of the joint rather than breaking. A suspected fracture requires prompt medical evaluation.

What are the bones of the elbow?

The elbow joint is made up of three bones: the humerus, the ulna, and the radius:

• The humerus (the upper arm bone)
• The ulna (the forearm bone on the little finger side)
• The radius (the forearm bone on the thumb side)

One or more of these three bones may be fractured. Fractures of the radial head and olecranon are among the most common elbow fractures in adults : ^{1, 2}

• Fracture of the radial head (the end of the radius near the elbow)
• Olecranon fracture (the bony protrusion at the elbow, which is part of the ulna)

What are the causes of an elbow fracture?

An elbow fracture often occurs after a fall or a blow. A fracture can also occur without a major accident: due to repeated stress on the bone (a stress fracture, in people who throw a lot, for example) ³ or in a bone that is already weakened, sometimes following minor exertion or impact ⁴. Common causes of elbow fractures include:

• Falling on the elbow or hand
• Impact directly on the elbow (by a heavy object, for example)

Pain that develops gradually, without any obvious injury, can have several causes. Stress fractures are rare, but the absence of an injury is not enough to rule them out. Pain that persists or worsens warrants evaluation.

What are the symptoms of an elbow fracture?

An elbow fracture often causes pain after a fall or a blow. The arm may become weak and difficult to bend or straighten. Swelling or a bruise—a blue mark under the skin—may also appear.

What are the most common symptoms?

Common symptoms of an elbow fracture include pain, stiffness, and difficulty using the arm:

• Elbow pain that developed after a fall or an accident
• Weakness and pain in the arm when lifting loads and clenching the fist
• Pain, stiffness, and difficulty bending and straightening the elbow (often unable to fully extend the elbow)
• There may be swelling and bruising on the elbow

There may or may not be a visible deformity of the elbow.

How to diagnose an elbow fracture?

The doctor will look for a fracture in the elbow based on the circumstances of the injury, an examination of the arm, and an X-ray of the elbow—an image of the bones obtained using X-rays. Some small fractures may not be visible on the initial X-rays. Medical follow-up is still necessary if symptoms persist, even if the first X-ray appears normal.

After an injury, the following signs warrant a medical evaluation to determine which tests are necessary:

• Inability to fully straighten your elbow ^{5, 6}
• Visible deformity of the elbow
• The pain doesn't get better over time.

Being able to straighten your elbow is not enough to rule out a fracture. In the two studies cited, some people who could straighten their elbows still had a fracture. Do not force the movement to test yourself.

Allez à l’urgence après une blessure si le bras est déformé, si vous ressentez un engourdissement ou des picotements, si un os traverse la peau ou si une plaie saigne abondamment. Une douleur très forte ou qui augmente, une enflure importante ou qui s’aggrave, ou une difficulté à bouger demande aussi un avis médical rapide. Après la blessure, une forte fièvre ou une sensation de chaud, de froid ou des frissons demande également cet avis. Appelez le 911 si vous avez besoin d’une ambulance. Ces signes d’alerte après une blessure au bras ne doivent pas attendre un rendez-vous de physiothérapie⁷.

Au Québec, un physiothérapeute qui détient l’attestation requise peut prescrire une radiographie pour une blessure survenue il y a moins de 72 heures. Il doit être le premier professionnel à vous évaluer pour cette blessure, sans consultation médicale préalable, et juger la radiographie indiquée. L’Ordre professionnel de la physiothérapie du Québec précise ces conditions⁸. La fracture confirmée nécessite ensuite une prise en charge médicale.

When should you see a physiotherapist for an elbow fracture?

La physiothérapie après une fracture au coude commence selon les mouvements permis par l’équipe qui soigne la fracture. Le type de fracture, le maintien des fragments osseux en place et une éventuelle opération comptent dans cette décision. Le plâtre et la douleur ne suffisent pas à déterminer le bon moment. Les recommandations sur les fractures de la tête radiale⁹ et les fractures de l’olécrâne¹⁰ décrivent des calendriers différents selon la blessure et son traitement.

A study conducted among adults who underwent surgery for an olecranon fracture linked initial elbow instability and fracture type to the recovery of movement and changes in osteoarthritis. Osteoarthritis is a condition that primarily affects cartilage, the smooth tissue that covers the ends of bones within a joint ¹¹.

What are the reasons for seeing a physical therapist?

A physical therapist can help you regain movement and strength in your arm, while taking into account the limitations caused by the fracture. Ask the medical team when to start the exercises and which parts of your arm you can move.

• If you are not wearing a cast, begin moving your elbow once the medical team gives you the go-ahead. With some simple fractures, you can start moving your elbow early.
• If you are wearing a cast, let the medical staff know if you experience increasing pain or a feeling of tightness. A physical therapist can also advise you on what activities and movements are permitted.
• Even if you are not in pain, keep the cast on as directed. After it is removed, gradually resume movement and build up strength according to the planned schedule.

If you’re not sure what to do, your physical therapist can advise you on which activities are safe and refer you to a doctor if necessary. However, the warning signs described above require immediate medical attention.

What are the physiotherapy treatments for an elbow fracture?

Physical therapy after an elbow fracture helps restore movement, strength, and function in the arm. The program may include exercises, movements guided by the physical therapist, and advice on resuming activities. Each session adheres to the range of motion and weight-bearing limits permitted for the fracture.

Your physical therapist will assess the following, to the extent permitted by the treatment of the fracture:

• Your ability to bend and straighten your elbow, and then turn your palm up or down
• Symptoms related to the nerves, which transmit sensory and motor signals, and their response when the arm moves within the permitted range
• The quality of your movements
• Your strength and your arm's ability to remain stable during permitted movements

What will your physical therapist do based on the results of the evaluation?

Your physical therapist will tailor the exercises and advice to the specific issues observed and to the healing process of the fracture:

• Guide the movements of your elbow with their hands, when permitted, to help you move with less pain
• Vous proposer des exercices adaptés pour travailler :
  
  • Controlling elbow movements
  • Elbow stability and strength
  • Elbow mobility
• Adapt the exercises to help you move with less pain
• To teach you how to balance your daily activities and leisure time while you're recovering
• To advise you on comfortable positions and everyday movements.

After a fracture, the bone heals and then undergoes a long process of reorganization to regain its strength. Movement may be resumed before this reorganization is complete, depending on the stability of the fracture and medical advice. ^{12, 13}

Dans un essai auprès de 180 personnes ayant une fracture simple de la tête radiale, les groupes qui reprenaient les mouvements immédiatement ou après deux jours ont obtenu de meilleurs résultats que le groupe immobilisé sept jours¹⁴. Le groupe qui attendait deux jours avait les meilleurs résultats de mouvement, de force et d’usage du coude. Le début immédiat causait toutefois plus de douleur durant les trois premiers jours. Ces résultats appuient un mouvement précoce adapté; ils ne fixent pas le calendrier de toutes les fractures du coude.

What to do at home for an elbow fracture?

At home, protect your elbow and follow the medical team’s instructions regarding support, movement, and weight-bearing. Protecting your arm and doing the permitted exercises can be part of the same plan.

If you suspect a fracture, have the arm examined promptly. In the meantime, support it with a sling or triangular bandage, without forcing the elbow into any particular position. Do not use the injured arm to carry anything. After the examination, keep the splint, a brace that restricts movement, or the cast on as directed. Perform only the movements that are permitted.

In a study of British medical records involving multiple fracture sites, diabetes was associated with a higher risk of bone healing problems ¹⁵.

What other tips can help at home?

Comfortable arm support can reduce discomfort during the day and at night. Follow the advice below, taking into account the instructions for your splint or cast:

• Support your arm with a pillow or armrest, without forcing your elbow into an unnatural position. Use the support recommended by your healthcare team.
• If you experience pain at night or stiffness in the morning, make sure your neck is properly supported by a comfortable pillow. Avoid placing your arm behind your head or under the pillow if this puts strain on your elbow. Keep your arm supported in the position recommended by the medical team.
• Avoid sleeping on the painful side.

Contactez rapidement l’équipe médicale si le plâtre devient trop serré ou trop lâche, si la douleur augmente, si les doigts changent de couleur ou s’engourdissent, ou si une mauvaise odeur ou un écoulement vient du plâtre. Une forte fièvre ou une sensation de chaleur avec des frissons nécessite aussi un avis rapide. Une incapacité à bouger les doigts demande une évaluation urgente. Ces signes sous un plâtre ou une attelle doivent être évalués avant de poursuivre les exercices¹⁶.

Sources

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Nos physiothérapeutes ont défini la stratégie de recherche, le plan et le contenu clinique de cet article. Un outil d’IA a soutenu la recherche documentaire et la révision du texte pour assurer une cohérence du contenu et du style d’écriture.