ELBOW FRACTURE, LOWER HUMERUS
DEFINITION--A complete or incomplete break in the lower end of the humerus at the elbow joint.
BODY PARTS INVOLVED
Lower end of the humerus (upper arm bone).
Soft tissue surrounding the fracture site, including nerves, tendons, ligaments, blood vessels, cartilage and muscles.
SIGNS & SYMPTOMS
Severe elbow and arm pain at the time of injury.
Swelling around the fracture.
Visible deformity if the fracture is complete and bone fragments separate enough to distort normal body contours.
Tenderness to the touch.
Numbness or coldness in the elbow, lower arm and hand, if the blood supply is impaired.
Direct blow to the elbow.
Indirect stress due to falling on an outstretched hand with the elbow locked.
RISK INCREASES WITH
Contact sports such as football.
Children under 10 years.
History of bone or joint disease, especially osteoporosis.
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 adequate muscle strength and achieve good conditioning prior to exercise, athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
Use appropriate protective equipment, such as padded elbow pads for contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment to aspirate blood from the elbow joint, manipulate the broken bones and repair soft tissue of the elbow.
Hospitalization for anesthesia and surgery to set the fracture and repair soft tissues.
Whirlpool, ultrasound or massage (to displace excess fluid from the injured joint space).
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of injured areas, including joints above and below the primary injury site.
AT THE TIME OF INJURY:
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.
Unstable or arthritic joint following repeated injury.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Problems caused by casts. See Appendix 2 (Care of Casts).
Atrophy of muscles and poor hand control due to damage to blood vessels, nerves, cartilage, tendons, muscle, ligaments and fascia (thin covering of muscles).
PROBABLE OUTCOMEThe average healing time for this fracture is 6 to 8 weeks in adults and 4 to 6 weeks in children. Healing is considered 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.
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing, if possible. Don't move the injured area to remove clothing.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will realign and set the broken bones either with surgery or, if possible, without. 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.
Immobilization will be necessary, usually with rigid splints around the elbow and wrist.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use a heating pad or heat lamp for 30 minutes at a time so heat can penetrate the splints.
After the 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 or heating pads.
Take whirlpool treatments, if available.
MEDICATIONYour doctor may prescribe:
General anesthesia for surgery.
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen for mild pain.
Actively exercise all muscle groups not immobilized. These muscle contractions promote fracture alignment and hasten healing.
Resume normal activities gradually after treatment. Don't drive until healing is complete.
Begin reconditioning the injured area after clearance from your doctor.
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 or 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.
Blue or gray skin color beyond the cast, particularly under the fingernails.
Numbness or complete loss of feeling below the fracture site.
Nausea or vomiting.