Dislocation with fracture of the elbow (dislocation fracture)

Anatomy of the elbow – why stability is so important

The elbow is made up of three bones: the humerus, the radius, and the ulna. The bony joint partners are stabilized by a strong capsule and ligament structures - especially. a. the medial (ulnar) and lateral (radial) collateral ligaments. Muscles and tendons guide the joint and control flexion, extension and rotational movements of the forearm (pronation/supination).

• Important bony parts: Olecranon (ulna tip), coronoid process (crown process), radial head, humeral condyles
• Ligament apparatus: ulnar/medial and radial/lateral, plus annular ligament of the radius
• Nerves in the immediate vicinity: ulnar nerve, median nerve, radial nerve
• Vascular supply from the brachial artery and its branches

If a dislocation occurs with an accompanying fracture, not only bones are often affected, but also ligaments and capsules. This results in an increased risk of instability and restricted movement.

What is a dislocation fracture of the elbow?

A dislocation fracture occurs when the elbow joint is dislocated and one or more parts of the bone are broken at the same time. The ligamentous structures are usually also injured. Well-known patterns are e.g. B. the so-called “Terrible Triad” (elbow dislocation + fracture of the radial head + fracture of the coronoid process) or injuries as part of a Monteggia fracture (fracture of the ulna with dislocation of the radial head).

• Simple dislocation: without fracture – usually treatable conservatively
• Complex dislocation: with fracture (“dislocation fracture”) – often requiring surgery
• Open injury: cut skin – emergency with risk of infection

The precise classification is important because it results in the choice between conservative stabilization after reduction or surgical reconstruction of bones and ligaments.

Typical symptoms and warning signs

• Acute, severe pain in the elbow
• Visible and palpable misalignment, swelling, bruising
• Inability to move, painful blockage
• Tingling, numbness or weakness in hand/fingers (indication of nerve involvement)
• Paleness, feeling cold, no pulse in the hand (vascular involvement – ​​emergency)

In the case of open wounds, severe deformity, sensory disturbances or blood circulation problems, emergency care should be provided immediately. Independent attempts at adjustment should be avoided.

Causes and risk factors

The injury usually occurs as a result of a fall on an outstretched arm, sports collisions or a traffic accident. The acting force leads to dislocation; At the same time, bony stabilizers such as the coronoid process or the radial head break.

• Fall from height, sports trauma (e.g. handball, cycling, horse riding, skating)
• Direct violence, traffic accident
• Previous ligament laxity, instability, rarely bone quality/energy impact
• Occupational/hobby risks with risk of falling

Diagnostics: fast and structured

After anamnesis and examination, we check blood circulation, motor function and sensitivity (neurovascular status). Imaging typically includes x-rays in two planes. In complex dislocation fractures, CT is often required to accurately depict fracture lines, comminution zones, and joint involvement. An MRI can also show the extent to which the ligamentous and soft tissue structures are affected.

• Clinical examination including nerve/vascular check
• X-ray (ap.-p. and lateral) for initial assessment
• CT for surgical planning for complex fractures
• MRI if relevant ligament/soft tissue injury is suspected
• Assessment for open injury or associated trauma

First aid in an emergency – what makes sense?

If a dislocation fracture is suspected: immobilize, elevate, cool carefully (not directly on the skin), and stabilize the arm in a sling. Do not adjust yourself. If you have severe pain, misalignment, numbness or circulatory problems: call emergency services or go to the emergency room.

• Immobilization and protection, if necessary improvised splint
• Cooling in short intervals to protect skin
• No manipulative attempts at adjustment
• Rapid medical clarification, especially in the case of neurological/vascular warning signs

Treatment: conservative first – surgery if necessary

The goal of therapy is a stable, pain-adapted elbow that can be moved again early on. After rapid reduction (readjustment), stability is checked. Purely conservative treatment is only possible if the joint is stable after reduction and the fractures are small, not displaced and functionally insignificant.

Conservative therapy

• Closed reduction in acute care (usually clinic/emergency room)
• Short-term immobilization (e.g. upper arm splint/sling), pain and swelling management
• Early functional mobilization under protection once stable
• Regular checks (clinical and imaging) to avoid misalignment and stiffness

Conservative comes from a. in a stable post-reposition situation, e.g. B. for small avulsion fractures, non-displaced fractures and intact function. The decision is made individually based on imaging and stability tests.

Surgical therapy – when it makes sense

• Instability after reduction (dislocation tends to dislocate again)
• Relevant displaced fractures (e.g. radial head, coronoid process, olecranon, humeral condyles)
• Joint level, blocking or entrapment of fragments
• Open injuries or vessel/nerve compression

Fractures are surgically stabilized according to the anatomy (e.g. screws/plates or prosthetic replacement of the radial head in selected cases) and injured ligament structures are reconstructed. If instability persists, a hinged external fixator can be used temporarily. The exact technique depends on the injury pattern and tissue quality.

Regenerative additional procedures (e.g. PRP) are not standard of care for acute dislocation fractures. We provide transparent advice on individual, supplementary measures, taking into account the available evidence.

Follow-up treatment and rehabilitation

Structured follow-up treatment is crucial to avoid stiffness and restore function. After short-term immobilization, early functional mobilization takes place - adapted to stability and pain. Physiotherapy takes place gradually and is based on the healing process and clinical control.

• Pain and swelling management (cooling, protection, if necessary medication as prescribed by a doctor)
• Early mobilization with limited stretching (extension block) depending on stability
• Physiotherapy: passive/assistive mobilization, later active movements, proprioception
• Scar care and soft tissue management after surgery
• Building strength and coordination from consolidated healing
• Clear load and movement limits according to follow-up checks

The time it takes to increase the load varies. Everyday activities are often possible after a few weeks, sporting activities only after there is sufficient stability and range of movement - this is determined individually.

Possible complications – what we keep an eye on

• Joint stiffness and limited range of motion
• Instability or re-dislocation
• Heterotopic ossifications (increased bone formation in the soft tissue)
• Nerve irritation/injuries (e.g. ulnar nerve)
• Vascular complications, rarely compartment syndrome
• Post-traumatic osteoarthritis, chronic pain
• Complex regional pain syndrome (CRPS)

The risk of complications increases with severe underlying injury, delayed reduction, open fracture and severe soft tissue damage. Close follow-up care helps to identify and treat problems early.

Healing process and prognosis

The prognosis depends on the pattern of injury, tissue quality, accompanying injuries and the possibility of early, safe mobilization. Many patients achieve function that is suitable for everyday use, although a small loss of movement - especially in extension - is not uncommon. Timely reduction, adequate stabilization and consistent but moderate rehabilitation are crucial.

• Bone healing typically takes weeks to a few months
• Functional recovery is gradual and may take several months
• Return to contact sports only after clearance and sufficient stability

Prevention and everyday tips

• Fall prevention: secure the environment, non-slip shoes, balance and strength training
• Sport-appropriate technology, safety and protective equipment depending on the discipline
• Pay attention to workplace safety and use aids
• Support bone and muscle health through exercise and a balanced diet

Sport and work: realistic return

The return to sport and work will take place gradually. Activities with high falls or peak loads require stable healing and sufficient range of motion. Together we will create an individual plan that determines increases in workload and milestones - without haste and tailored to your goals.

When should I seek medical attention?

• Immediately in case of misalignment, severe pain, numbness, cold feeling of the hand or open wounds
• If swelling increases, pain despite rest, fever or redness after initial care
• If there is persistent restriction of movement or a feeling of instability during the healing phase

Your treatment in Hamburg: think conservatively, act specifically

In our orthopedic practice at Dorotheenstrasse 48, 22301 Hamburg, you will receive a structured assessment and an evidence-based recommendation. We prioritize conservative options whenever safely possible. If an operation makes sense, we advise on the procedure, coordinate inpatient care in partner clinics if necessary and take care of close follow-up care and rehabilitation.

• Careful diagnostics including imaging and functional testing
• Graded conservative therapy and early mobilization
• Transparent indication for surgery without any promise of cure
• Individual rehabilitation and return-to-activity planning

Related elbow injuries

• Radial head fracture – often part of the “Terrible Triad”
• Olecranon fracture – fracture of the tip of the ulna
• Humeral condylar fracture – knee joint-like parts of the humerus
• Monteggia fracture – Ulnar fracture with dislocation of the radial head
• Stress fractures – rarely in the elbow, more likely due to overuse