Elbow Fractures

Elbow fractures are breaks of the bones that make up the elbow joint, and they range from a small crack in the radial head to a shattered lower end of the upper arm bone. They matter because the elbow is a precise hinge: a poorly healed break can leave it stiff, weak or painful. This page covers the types, treatment and recovery, including options abroad.

What are elbow fractures?

The elbow joint is formed by the humerus (upper arm bone), the ulna (the larger forearm bone on the little finger side) and the radius (the forearm bone on the thumb side). A fracture is a crack or break in any of them. Doctors group elbow fractures by the bone involved and by whether the joint surface is damaged.

A broken elbow can be a hairline crack that barely moves, or a break in many pieces with the bone ends displaced. This difference decides almost everything about treatment.

Who gets elbow fractures?

In adults, radial head breaks are the most common elbow fractures, usually after a fall onto the outstretched hand. Olecranon breaks follow a fall directly onto the point of the elbow. Distal humerus breaks are less common and tend to affect either young people in high-energy accidents or older women with thin bone.

Children are affected too, especially around the age of 5 to 10, when a fall from monkey bars or a trampoline can break the lower humerus.

How serious are elbow fractures?

Most elbow fractures heal, but they can be difficult injuries because the joint is small and surrounded by nerves and vessels. Poorly treated breaks risk stiffness, arthritis and nerve problems. Open breaks, where bone breaks the skin, and those with numbness or a pale hand are emergencies.

How this page is organised

We start with how the elbow is built, then symptoms, causes and fracture types. Diagnosis, look-alike conditions, non-surgical care, self-care and surgery follow. Later sections cover when to consider surgery, treatment abroad, complications, prevention and outlook. Our elbow area page gives general background.

The elbow is built so that three bones fit together in a tight, interlocking arrangement, and a fracture breaks that fit. Knowing the parts makes the X-ray report and the surgeon's explanation easier to follow. Here is what lies beneath the skin.

Which bones make up the elbow?

At the lower end of the humerus are two rounded surfaces: the trochlea, shaped like a spool, and the capitellum, shaped like a ball. The ulna hooks around the trochlea at its upper end, where the olecranon forms the bony point you feel behind the elbow. The radial head, a small disc at the top of the radius, meets the capitellum.

Two bony bumps on either side of the lower humerus, the medial and lateral epicondyles, anchor the forearm muscles and ligaments.

How does the elbow move?

The joint offers two kinds of motion. The humeroulnar hinge bends and straightens the arm over roughly 140 degrees. The radius rolls around the ulna so the forearm can turn the palm up and down. Because both motions share one capsule, a fracture in one area can limit the other.

What nerves and vessels are at risk?

The ulnar nerve runs in a groove behind the inner bump. The radial nerve and its branch, the posterior interosseous nerve, lie near the outer side and the radial neck. The median nerve and the brachial artery pass in front. Sharp bone fragments or swelling can injure them, so doctors check hand sensation and pulses early.

What happens when the elbow breaks?

A break separates the bone into fragments that may move apart. If the cartilage-covered joint surface is involved, the surface may no longer match. Ligaments attached to the broken pieces lose their anchor, so the elbow can become unstable. Healing then depends on the blood supply to each fragment and on how well the pieces are lined up.

Elbow fractures are named for the bone and the part of the bone that breaks. The name predicts how stable the elbow is and whether surgery is likely. Four groups cover most of what doctors see.

What is a radial head fracture?

A radial head fracture is a break in the small disc at the top of the radius. Doctors often use the Mason classification. Type I breaks are undisplaced, type II have a displaced fragment, and type III are comminuted, meaning broken into several pieces. Type I usually heals in a sling with early movement, while larger displaced fragments may need screws or a replacement head.

What is an olecranon fracture?

An olecranon fracture is a break in the bony tip of the ulna that forms the point of the elbow. The triceps tendon attaches there, so a displaced break stops you straightening the arm against gravity. Displaced olecranon fractures are usually fixed with a wire and pins or a plate, because a cast cannot hold them together.

What is a distal humerus fracture?

A distal humerus fracture involves the lower end of the upper arm bone. It may be a break above the joint, a split between the columns of bone, or a fracture of the capitellum or trochlea. These are among the harder elbow fractures to treat, as the fragments are small and the cartilage surface must be restored accurately. In frail older patients, a total elbow replacement can be considered.

What about coronoid and children's fractures?

The coronoid process is a small hook at the front of the ulna that stops the forearm sliding backwards. Breaking it makes the elbow unstable and often accompanies a dislocation. In children, the supracondylar fracture just above the elbow is the commonest type, and may need pins to hold the bone.

Elbow fractures are diagnosed by a clinical examination and X-rays, with a CT scan added when the pattern is complex. The doctor looks for the break itself and for injuries to nerves, vessels and ligaments. A clear picture is needed before choosing between a splint and surgery.

How is the history taken?

The clinician asks how you fell, which part of the arm hit the ground, whether you felt a crunch and whether the hand tingled. They ask about your age, hand dominance, work, sport and conditions like diabetes or osteoporosis. They also note medicines that thin the blood or affect healing, and whether you smoke.

What does the examination include?

The examination checks the skin for cuts, the swelling pattern, the point of maximum tenderness and the movement that is possible. The surgeon checks the pulses at the wrist, capillary refill in the fingertips and the strength and sensation of the radial, median and ulnar nerves. The shoulder and wrist are examined too, because associated injuries are common.

Which imaging is used?

Plain X-rays from the front and side usually show the break. A "fat pad sign" on the side view, a dark triangle of fluid, can hint at a hidden fracture even when the bone line is not seen. CT scans with three-dimensional reconstruction show how many fragments exist and whether the joint surface is involved, and they are very helpful when planning surgery.

MRI is used for suspected cartilage or ligament injury, and for stress fractures that do not show on X-rays.

What to prepare for a remote opinion

Send the date of injury, every X-ray and CT in digital format, emergency and operation notes, current splint details and any nerve symptoms. Photographs and a short video of how far you can move are useful. The medical record review guide explains how our team reads these files.

Non-surgical treatment works for elbow fractures that are stable, have little displacement and leave the joint surface smooth. The goal is to protect the bone just long enough for it to knit, while keeping the joint moving so it does not stiffen. Here is how that usually unfolds.

Which fractures can be treated without surgery?

Undisplaced radial head fractures, small undisplaced olecranon fractures, many childhood supracondylar fractures with minimal angulation and some stable coronoid tip fractures can often be managed in a sling or splint. The surgeon decides after reviewing X-rays or CT, and checks again after about 1 week to make sure the pieces have not shifted.

What does the initial treatment involve?

Initial care includes a padded splint or a sling, ice, elevation above heart level and pain relief. Acetaminophen (paracetamol) and anti-inflammatory medicines are commonly used, with stronger options for a few days if needed. Your doctor will weigh any risk of anti-inflammatory medicines on bone healing and the stomach.

How long is the arm immobilised?

For a simple radial head break, a sling is often used for only 1 to 2 weeks, with early gentle movement beginning as soon as pain allows. For an undisplaced olecranon or humerus fracture, a splint may be worn for about 3 weeks before movement starts. Too much rest tends to cause stiffness, so teams aim for the shortest safe period.

When does physiotherapy start?

Physiotherapy usually starts once the bone is stable enough, often between 1 and 3 weeks. It begins with active bending, straightening and forearm rotation, and later adds strengthening. Healing of the bone typically takes 6 to 8 weeks, while soft-tissue and strength recovery continues beyond that.

What is the typical broken elbow recovery time?

A broken elbow recovery time for a simple, non-surgical break is often 6 to 12 weeks for bone healing and 3 to 4 months for most functional recovery. Complex breaks and surgical repair can need 6 to 12 months to reach a final result, and some loss of full straightening is common.

How is progress checked?

Repeat X-rays at about 1 to 2 weeks and again at 6 weeks check that the bone is staying in position and beginning to heal. If the fragments move, surgery may be recommended later. Missing a follow-up is a common reason a small problem becomes a large one.

What does the evidence suggest?

Studies suggest that for undisplaced radial head fractures, early movement gives better motion than prolonged immobilisation, with similar bone healing. For displaced olecranon fractures, however, a cast alone usually cannot control the pull of the triceps, which is why most are fixed surgically.

Surgery for elbow fractures is chosen when the bone pieces are displaced, when the joint surface does not line up, or when the elbow is unstable. The aim is to rebuild the elbow so that it moves early and heals in a good position. These are the main options.

Internal fixation with plates and screws

Internal fixation is the most common repair. After a cut over the elbow, the surgeon puts the fragments back together and holds them with plates, screws or wires. Pre-contoured plates are designed for the distal humerus, and small screws can fix a radial head fragment. This forms the basis of elbow fracture surgery, and the pathway abroad is shown on our elbow fracture surgery in turkey page.

Tension band wiring for the olecranon

For a transverse olecranon break, two pins and a figure-of-eight wire convert the pull of the triceps into compression across the break. A plate is preferred when the break is oblique or in several pieces. Hardware can be prominent under the skin and is sometimes removed after healing.

Radial head fixation or replacement

If the radial head is split in a few large pieces, screws can reassemble it. When it is crushed beyond repair, the surgeon may remove it and insert a metal radial head prosthesis, especially when the elbow is unstable. Simply removing it without replacement is reserved for selected, stable cases.

Total elbow replacement

In older patients with brittle bone and a shattered lower humerus, the pieces may be too small to hold screws. A total elbow replacement substitutes the joint with a metal and plastic implant. It can allow early movement but comes with weight limits for the arm, typically around 2 to 5 kg of repeated lifting. The total elbow replacement in turkey page explains what planned treatment involves.

What are the trade-offs?

Surgery gives better alignment and allows early movement, but carries risks of infection, wound healing problems, nerve injury, stiffness and hardware irritation. Not operating avoids those risks but can leave a displaced bone that heals badly. Costs are covered in our elbow fracture surgery cost guide and the total elbow replacement cost guide.

Many elbow fractures follow falls, so prevention centres on fall avoidance, bone health and protective equipment. Some injuries cannot be avoided, especially those from road accidents. Even so, a few habits cut the odds and improve healing if a break does occur.

How can I reduce the risk of falls?

Keep walkways clear, fix loose rugs, install good lighting and rails on stairs, and wear well-fitting shoes. Review medicines that cause dizziness with your doctor, and have your eyesight checked regularly. Balance and strength exercise, such as tai chi, lowers fall risk in older adults.

How do I protect bone health?

Eat enough calcium and vitamin D, do weight-bearing exercise, avoid smoking and limit alcohol. After 50, discuss bone density testing with your doctor, particularly after a previous low-energy fracture. Osteoporosis treatment can lower the risk of further breaks.

What protective gear helps?

Wear elbow and wrist guards for skating, snowboarding, cycling and similar sports. Use helmets and appropriate protective equipment in contact sports. For children, supervise play on high equipment and ensure the surface below is soft.

How do I prevent a second injury during recovery?

While the bone is healing, avoid situations with a risk of falling, such as icy paths, and use the other hand for balance. Follow weight-bearing limits exactly. Return to sport in stages as your surgeon advises.

What cannot be prevented?

High-energy accidents and sudden stumbles will always occur. The aim then shifts to quick assessment, accurate treatment and thorough rehabilitation. Telling your surgeon about earlier injuries and bone problems helps tailor the plan.

Most people with elbow fractures recover good use of the arm, but the final result depends heavily on the type of break and the quality of rehabilitation. Simple breaks often recover almost completely. Complex fractures of the joint surface leave more residual stiffness, so expectations should be realistic.

What is the natural history of an elbow fracture?

Bone usually unites in about 6 to 12 weeks, although smoking, diabetes and poor blood supply can slow it. After the bone has healed, the soft tissues remodel and strength builds slowly. Aching in cold or damp weather is common for a year or more.

What is the typical broken elbow recovery time?

Broken elbow recovery time is most often 3 to 6 months to regain useful movement and strength after a simple break. After surgery for a complex distal humerus fracture, a final range of motion can take up to 12 months. Most gains occur in the first 6 months.

When can I return to work and sport?

Desk work is often possible within 2 to 6 weeks, and light duties with the other hand are possible sooner. Heavy manual work usually needs 3 to 6 months. Contact or throwing sport commonly returns after 4 to 6 months once the bone is healed and strength is near normal, if the surgeon agrees.

What are the long-term results?

Studies suggest that many patients regain a functional arc of about 100 degrees, which is enough for most daily tasks. Complex fractures may lose some strength and straightening. After a total elbow replacement, patients are usually advised to avoid heavy repetitive lifting to protect the implant.

What affects the outcome?

Accurate repair, early movement, non-smoking, good nutrition and attendance at therapy all help. Open injuries, nerve damage and bone fragility reduce the chance of a perfect result. Take an active part in your recovery and ask questions at each review. A free case review can help you plan next steps.