Elbow Fracture Clinical Presentation

  • Author: Daniel K Nishijima, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 1, 2012
 

History

Mechanism of injury for most elbow fractures is direct elbow trauma or a fall onto an outstretched hand. Patients may experience the following:

  • Pain
  • Swelling
  • Decreased range of motion
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Physical

A thorough neurovascular examination is vital in the assessment of elbow fractures because of the high incidence of neurovascular injuries with elbow fractures and the subsequent long-term complications with these injuries.

With supracondylar fractures, the incidence of anterior interosseous nerve injury is high, and specific muscle testing of flexion at the distal interphalangeal joint of the index finger should be performed.[9]

Patients often have decreased range of motion, and pain is present with pronation/supination of the forearm.

Edema and ecchymosis near the elbow may be evident.

Perform careful shoulder and wrist examinations with all elbow injuries.

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Contributor Information and Disclosures
Author

Daniel K Nishijima, MD  Staff Physician, Department of Emergency Medicine, University of California Davis Medical Center

Daniel K Nishijima, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Matthew Goldman, MD  Associate Medical Director, Department of Emergency Medicine, Southside Hospital, NS-LIJ

Matthew Goldman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francis Counselman, MD, FACEP  Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Tom Scaletta, MD  Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

Thank you Sabrina Sakata for your editing and encouragement.

References

  1. Kuntz DG Jr, Baratz ME. Fractures of the elbow. Orthop Clin North Am. Jan 1999;30(1):37-61. [Medline].

  2. Gupta R. Intercondylar fractures of the distal humerus in adults. Injury. Oct 1996;27(8):569-72. [Medline].

  3. Wilkins KE. Fractures and dislocations of the elbow region. In: Rockwood CA, Wilkins KE, King RE, ed. Fractures in Children. 4th ed. Philadelphia: JB Lippincott; 1996:653.

  4. Brown IC, Zinar DM. Traumatic and iatrogenic neurological complications after supracondylar humerus fractures in children. J Pediatr Orthop. Jul-Aug 1995;15(4):440-3. [Medline].

  5. Geiderman JM. Humerus and elbow. In: Marx JA. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia: Mosby; 2006:Chap 49.

  6. Harris IE. Supracondylar fractures of the humerus in children. Orthopedics. Jul 1992;15(7):811-7. [Medline].

  7. Nicholson DA, Driscoll PA. ABC of emergency radiology. The elbow. BMJ. Oct 23 1993;307(6911):1058-62. [Medline].

  8. Skaggs D, Pershad J. Pediatric elbow trauma. Pediatr Emerg Care. Dec 1997;13(6):425-34. [Medline].

  9. Shearman C, el-Khoury GY. Pitfalls in the radiologic evaluation of extremity trauma: Part 1. The upper extremity. Am Fam Physician. 1998;58:1298. [Medline].

  10. Karlsson MK, Hasserius R, Karlsson C, et al. Fractures of the olecranon: a 15- to 25-year followup of 73 patients. Clin Orthop. Oct 2002;205-12. [Medline].

  11. Steinberg G, Adkins C, Baran D. Orthopaedics in Primary Care. 2nd ed. Williams & Wilkins; 1992:62-85.

  12. Roust AF, Bredenkamp JH, Uehara DT. Injuries to the elbow and forearm. In: Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York: McGraw Hill Text; 2003:1691-1694.

 
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Intercondylar fracture.
Supracondylar fracture.
Displaced supracondylar fracture.
Medial epicondyle fracture.
Lateral condyle fracture.
Radial head fracture.
Olecranon fracture.
Anterior and posterior fat pads with radial head fracture.
Cubitus varus.
Table. CRITOE.
Ossification CentersAge of Appearance, y
Capitellum1-2
Radial head4-5
Internal (medial) epicondyle4-5
Trochlea8-10
Olecranon8-9
External (lateral) epicondyle10-11
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