Elbow Fractures and Fracture-Dislocations
Elbow fractures can involve the distal humerus, radial head or neck, coronoid, olecranon, or several structures at once.
Common injury patterns
Elbow trauma may include olecranon fractures, radial head and neck fractures, coronoid fractures, distal humerus fractures, simple dislocation, terrible triad injury, and trans-olecranon or Monteggia-type fracture-dislocations. The injury can also damage collateral ligaments, tendons, nerves, blood vessels, and cartilage. A terrible triad injury combines elbow dislocation with fractures of the radial head and coronoid and disruption of the stabilizing ligaments. These patterns require treatment of the complete instability mechanism, not only the most visible fracture.
Evaluation
The initial assessment examines skin, swelling, deformity, nerve function, circulation, and whether the joint is reduced. X-rays define alignment and major fractures. CT imaging can show articular fragments, coronoid anatomy, radial head damage, and the relationship of the bones after reduction. MRI is not routinely necessary for an obvious complex fracture-dislocation because ligament injury is often inferred from the pattern, but it may be useful in selected cases. The patient's bone quality, health, occupation, and functional requirements influence the reconstruction.
Nonsurgical and surgical treatment
A stable, well-aligned injury may be treated with splinting or bracing and early protected motion. Repeat imaging is used to confirm that alignment remains acceptable. Surgery may include fixation of the olecranon, distal humerus, coronoid, or radial head; radial head replacement when the bone cannot be reconstructed; repair or reconstruction of collateral ligaments; and temporary internal or external stabilization for persistent instability. Total elbow replacement may be considered for selected unreconstructible fractures, particularly in patients with limited bone quality and lower loading demands.
Balancing stability and motion
The elbow becomes stiff quickly. Rehabilitation must protect healing bone and ligaments while restoring motion before scar tissue becomes permanent. The timing and safe arc of motion are determined by the stability achieved through reduction or reconstruction. Patients may require a hinged brace and close therapy supervision. Forearm rotation, elbow extension, and flexion are advanced according to the injury pattern and fixation.
Complications and urgent care
Potential complications include stiffness, instability, nonunion, malunion, infection, nerve dysfunction, heterotopic ossification, hardware irritation, post-traumatic arthritis, and additional surgery. Immediate evaluation is needed for an obvious deformity, open wound, cool or pale hand, absent pulse, new numbness or weakness, skin threatened by a fragment, severe swelling, or rapidly increasing pain.
This information is educational and is not a substitute for an individualized medical evaluation. Written and medically reviewed by Michael L. Knudsen, MD | Last reviewed: July 2026
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