Elbow Fractures: Symptoms, Types, Causes and Treatment

Injuries to the elbow are not only painful but can also affect the intricate balance of motion and strength in your arm. Whether resulting from sports, falls, or accidents, elbow fractures are common across all age groups—especially in children. Understanding the symptoms, types, causes, and latest treatment options is crucial for timely and effective management. This comprehensive guide synthesizes the latest research to help patients, caregivers, and healthcare professionals navigate the complexities of elbow fractures.

Symptoms of Elbow Fractures

Elbow fractures often present with a range of symptoms that can vary depending on the severity and type of fracture. Recognizing these early signs is essential for seeking prompt medical attention and preventing complications.

Symptom	Description	Age Group Most Affected	Source
Pain	Sharp or persistent pain in elbow/forearm	All ages	1 8
Swelling	Visible swelling around the joint	Children, adults	8 10
Bruising	Discoloration, may extend down the forearm	All ages	8 10
Deformity	Visible abnormal bend or bump	Children	1 8
Limited Motion	Difficulty moving elbow or arm	All ages	1 10
Numbness	Tingling or loss of sensation	More with severe types	1 8

Table 1: Key Symptoms of Elbow Fractures

Recognizing the Signs Early

Elbow fractures typically cause immediate, sharp pain at the site of injury. Swelling and bruising often develop rapidly, making the elbow appear puffy or discolored. In some cases, particularly with more severe fractures, the elbow may look deformed or bent at an unnatural angle. Children are especially prone to visible deformities due to the types of fractures they sustain, such as supracondylar fractures, which can push the bone out of alignment 1 8.

When to Suspect a Fracture

• Pain with Movement: If moving the elbow or arm triggers intense pain, a fracture should be suspected. Often, children and adults alike will instinctively hold the arm close to the body and refuse to use it 1 8.
• Swelling and Bruising: Swelling is usually swift and pronounced. Bruising may not appear immediately but often develops within hours, sometimes spreading down the arm 8 10.
• Deformity: A visible bump, bend, or abnormal contour of the elbow is a strong indicator of a displaced fracture, especially in children 1 8.
• Loss of Function: Inability to straighten or bend the elbow, or to rotate the forearm, is a serious sign and warrants urgent assessment 1 10.
• Nerve Symptoms: Severe fractures can injure nearby nerves, leading to numbness in the hand or fingers. This is seen more commonly in complex or displaced fractures and requires urgent medical attention 1 8.

Types of Elbow Fractures

Elbow fractures are not a single entity but a collection of specific injuries affecting different bones and parts of the joint. Each type has unique features and implications for treatment and recovery.

Type	Description	Prevalence in Children	Source
Supracondylar	Above the elbow joint (humerus)	Most common (44-58%)	1 3 4 6 8
Lateral Condyle	Outer part of the distal humerus	12-22%	4 6
Medial Epicondyle	Inner elbow (epicondylar epiphysis)	10%	3 5
Radial Neck/Head	Proximal radius (near elbow)	5-17%	3 6
Olecranon	Bony tip of the elbow (ulna)	7-8% (often missed)	3 6
Coronoid Process	Front of the ulna	Rare, complex injuries	3 12
Fracture-dislocations	Fracture plus joint dislocation	Variable, complex	7 9 12

Table 2: Main Types of Elbow Fractures

Supracondylar Fractures

These fractures occur just above the elbow joint in the humerus and are the most prevalent type in children, accounting for nearly half of all cases 1 3 4 6 8. They are especially common in boys aged 4-8 years, often resulting from a fall on an outstretched arm. Supracondylar fractures can be categorized further (e.g., Gartland types I-III) based on displacement and severity 1.

Lateral Condyle and Medial Epicondyle Fractures

Fractures of the lateral condyle (outer side) and medial epicondyle (inner side) of the distal humerus together make up a significant proportion of pediatric elbow injuries. Lateral condyle fractures are more likely to result from higher-energy trauma and may require surgery if displaced 4 6. Medial epicondyle fractures often occur with elbow dislocations and can be associated with the fragment being trapped in the joint 5.

Radial Neck/Head and Olecranon Fractures

Radial neck and head fractures are less common but still significant, especially in older children and adults 3 6. Olecranon fractures (at the elbow tip) are less frequent on initial radiographs but often show up on follow-up or can be associated with another fracture. They are sometimes missed due to their subtle appearance on early imaging 3 6.

Coronoid Process and Complex Injuries

Coronoid process fractures and fracture-dislocations (where the elbow joint is both fractured and dislocated) are more complex injuries. The "terrible triad" of the elbow—comprising a radial head fracture, coronoid process fracture, and elbow dislocation—is a particularly severe form 9 12. These injuries typically require specialized surgical management to restore joint stability.

Causes of Elbow Fractures

Understanding how elbow fractures occur can aid in both prevention and early detection. Different mechanisms give rise to distinct fracture types, often influenced by age and activity.

Cause	Mechanism	Common Fracture Types	Source
Falls	Fall on outstretched hand or elbow	Supracondylar, epicondyle	1 2 4 8
Sports	Skateboarding, cycling, athletics	Lateral condyle, supracondylar	4 6 8
Direct Impact	Blow to the elbow (e.g., collision)	Olecranon, distal humerus	2 3 6
High-energy	Traffic accidents, falls from height	Complex fractures, open	6 10 13

Table 3: Common Causes of Elbow Fractures

Falls: The Leading Cause

Falls—particularly onto an outstretched hand—are by far the most common cause of elbow fractures in both children and adults 1 4 8. This mechanism typically generates supracondylar and epicondylar fractures, especially in children who are active and prone to playground injuries 1 8.

Sports and Recreational Activities

Sports such as skateboarding, cycling, and climbing are increasingly implicated in elbow fractures among children aged 6-10 4. Skateboarding alone accounts for nearly 1 in 5 elbow fractures in this age group, highlighting the need for improved safety practices and protective gear 4.

Direct Blows and High-Energy Trauma

A direct impact to the elbow, such as from a collision or fall directly onto the joint, can cause fractures like the olecranon or distal humerus 2 6. High-energy trauma, including road traffic accidents or falls from significant heights, is more likely to cause complex or open fractures, sometimes involving multiple bones or the joint itself 6 10 13.

The Biomechanics of Injury

Research has shown that the specific position and angle of the elbow at the time of impact influence the fracture pattern:

• Radial head/coronoid fractures: Often occur when the forearm is partially flexed (up to 80°) and impacted along its length.
• Olecranon fractures: Result from a direct blow when the elbow is flexed at about 90°.
• Distal humeral fractures: More likely above 110° of flexion 2.

Understanding these patterns helps clinicians and patients alike recognize risky situations and potentially take preventive action.

Treatment of Elbow Fractures

Effective treatment of elbow fractures depends on the fracture type, patient age, degree of displacement, and any associated injuries. The main goals are to restore joint function, maintain stability, and prevent complications.

Approach	Main Methods	Indications	Source
Non-surgical	Casting, splinting, immobilization	Non-displaced, stable	10 12
Surgical	Open reduction, internal fixation	Displaced, unstable, open	10 12 13
Arthroplasty	Joint replacement (rare, adults)	Severe, unreconstructible	11
Early Motion	Rehabilitation, physical therapy	Most cases post-stabilization	10 12

Table 4: Overview of Treatment Approaches

Non-Surgical (Conservative) Management

For minor, non-displaced fractures, especially in children, immobilization with a cast or splint is often sufficient. The joint is held in a functional position for several weeks, followed by gradual rehabilitation to restore movement 10. Some coronoid and lateral condyle fractures can also be managed conservatively if stable 12.

Surgical Intervention

Surgery is indicated for:

• Displaced or unstable fractures
• Open fractures (where bone pierces the skin)
• Fracture-dislocations
• Injuries involving joint surfaces or nerve compromise 10 12 13

Techniques include open reduction and internal fixation (ORIF), where bones are realigned and held with pins, screws, or plates. In complex injury patterns (e.g., "terrible triad"), all involved structures (radial head, coronoid, ligaments) may need repair for optimal stability 9 12.

Open elbow fractures often arise from high-energy trauma and may be associated with other injuries. Prompt wound management, infection prevention, and sometimes multiple surgeries are required, especially for distal humeral fractures 13.

Arthroplasty (Joint Replacement)

In rare cases, particularly for older adults with unreconstructible distal humeral fractures, elbow hemiarthroplasty or total elbow replacement may be considered. This approach offers good pain control and function when fixation is not possible 11.

Rehabilitation and Early Motion

Regardless of treatment, early and guided motion is crucial to prevent stiffness and restore function. Physical therapy typically starts once the fracture is stable and initial healing has occurred. The main goal is to balance joint healing with maintaining range of motion 10 12.

Complications and Follow-Up

Complications can include nerve injury (especially with supracondylar fractures), joint stiffness, malunion, or, rarely, chronic infection in severe or open injuries. Most children and adults recover well with appropriate treatment, but close follow-up is essential to monitor healing and function 1 8 13.

Conclusion

Elbow fractures are common and potentially serious injuries that require timely recognition and tailored management. Prompt diagnosis and appropriate treatment are essential to restore function and prevent long-term complications. Here’s a quick recap of the main points:

• Symptoms: Pain, swelling, bruising, deformity, limited motion, and sometimes numbness are key warning signs.
• Types: The most frequent are supracondylar, lateral condyle, and medial epicondyle fractures in children; complex patterns may involve multiple bones and dislocations.
• Causes: Falls, sports, direct blows, and high-energy trauma are the primary culprits; biomechanics at the moment of injury influence fracture type.
• Treatment: Ranges from immobilization to complex surgery, with rehabilitation being a vital component of recovery.

Recognizing the symptoms early, understanding the injury type, and seeking specialized care can make a critical difference in outcomes for both children and adults.