ELBOW FRACTURE, RADIUS |
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General Information
DEFINITION--A complete or incomplete break in the head of the radius, one of the bones of the forearm.
BODY PARTS INVOLVED
Head of the radius.
Elbow joint.
Soft tissue surrounding the fracture site, including nerves, tendons, ligaments, blood vessels, cartilage and muscles.
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SIGNS & SYMPTOMS
Severe pain at the fracture site.
Swelling around the fracture.
Visible deformity if the fracture is complete and bone fragments separate enough to distort normal arm contours.
Tenderness to the touch.
Numbness and coldness in the lower arm and hand, if the blood supply is impaired.
CAUSES
Direct blow to the elbow.
Indirect injury due to falling on an outstretched hand with the elbow stiff, or any injury that causes dislocation of the elbow.
RISK INCREASES WITH
Contact sports such as football.
History of bone or joint disease, especially osteoporosis.
Poor nutrition, especially calcium deficiency.
Children under 12 or adults over 60.
Obesity.
If surgery is necessary, 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, when participating in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment to aspirate blood from the elbow joint and to remove the radial head surgically if it is shattered beyond repair.
Hospitalization for surgery to set the fracture and repair soft tissue of the elbow.
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 injured areas, including joints above and below the primary injury site.
Additional X-rays a week later if pain persists despite a normal X-ray immediately following the injury.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels, cartilage 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.
Proneness to repeated elbow injury.
Unstable or arthritic elbow following repeated injury.
Prolonged healing time if activity is resumed too soon.
Problems caused by casts or plaster splints. See Appendix 2 (Care of Casts).
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.
FIRST AID
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.
Use 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 and repair damaged soft tissue with surgery. Surgery is necessary for this injury to ensure normal rotation of the forearm after healing is complete. 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 of the elbow with rigid splints will be necessary.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use a heating pad or heat lamp so heat can penetrate the splints.
After splints are removed, use an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
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 for surgery.
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.
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.
REHABILITATION
Begin reconditioning the injured area after clearance from your doctor.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.
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 splints.
Blue or gray skin color beyond the splints, particularly under the fingernails.
Loss of feeling below the fracture site.
Nausea or vomiting.
Constipation.
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