ELBOW FRACTURE, EPICONDYLE |
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General Information
DEFINITION--A complete or incomplete break in the epicondyle of the humerus (the large bone in the arm between the elbow and shoulder). The epicondyle is located on the outside of the humerus at its lower end and forms a part of the elbow joint. This fracture is often accompanied by elbow dislocation.
BODY PARTS INVOLVED
Epicondyle of the humerus.
Elbow joint.
Soft tissue around the fracture site, including nerves, tendons, ligaments, joint membranes and blood vessels.
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SIGNS & SYMPTOMS
Severe elbow pain at the time of injury.
Swelling of soft tissue around the fracture.
Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal arm contours.
Tenderness to the touch.
Numbness and coldness in the hand and lower arm if the blood supply is impaired.
CAUSESDirect blow or indirect stress to the elbow. Indirect stress may be caused by twisting or violent muscle contraction.
RISK INCREASES WITH
Contact sports such as football or hockey.
History of bone or joint disease, especially osteoporosis.
Children under 12 or adults over 60.
Obesity.
If surgery or anesthesia is needed, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Build your strength with a good conditioning program before beginning regular athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
Use appropriate protective equipment, such as foam-rubber elbow pads, during participation in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment.
Hospitalization (sometimes) for surgical setting of the fracture.
Whirlpool, ultrasound or massage (to displace excess fluid from the injured joint space).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the arm from shoulder to wrist.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissues. AFTER TREATMENT OR SURGERY:
Delayed union or non-union of the fracture.
Impaired blood supply to the fracture site.
Avascular necrosis (death of bone cells) due to interruption of the blood supply.
Arrest of normal bone growth in children.
Infection in open fractures (skin broken over fracture site), or at the incision if surgical setting was necessary.
Shortening of the injured bones.
Problems caused by casts. See Appendix 2 (Care of Casts).
Prolonged healing time if activity is resumed too soon.
Proneness to repeated elbow injury.
Unstable or arthritic elbow following repeated injury.
PROBABLE OUTCOMEThe average healing time for this fracture is 6 to 8 weeks in adults and 4 to 6 weeks in children. Healing is complete when there is no motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing, if possible, but don't move the injured elbow to do so.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will set the broken bones with surgery or, if possible, without. The setting lines up the broken bones as close to their normal position as possible. Manipulation should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
CONTINUING CARE
Immobilization will be necessary, usually with plaster splints around the injured area to immobilize the elbow and wrist.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use a heat lamp or a heating pad for 30 minutes at a time so heat can penetrate the cast or splints.
After the cast or splints are removed, use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day.
Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
MEDICATIONYour doctor may prescribe:
General anesthesia, local anesthesia or muscle relaxants to make bone manipulation and fixation of bone fragments possible.
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen for mild pain.
ACTIVITY
Actively exercise all muscle groups not immobilized. These muscle contractions promote fracture alignment and hasten healing.
Begin reconditioning the elbow area after clearance from your doctor.
Resume normal activities gradually after treatment. Don't drive until healing is complete.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when movement is comfortable. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs and symptoms of an elbow fracture.
Any of the following occur after surgery or other treatment:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Swelling above or below the cast or splints.
Blue or gray skin color beyond the cast or splints, particularly under the fingernails.
Numbness or complete loss of feeling below the fracture site.
Nausea or vomiting.
Constipation.
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