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Trauma

Elbow Fractures

Radial Head, Olecranon & Distal Humerus Fractures

Comprehensive guide to elbow fractures - from simple to complex injury patterns

Types of Elbow Fractures

Radial Head Fractures

Most common adult elbow fracture

Fall on outstretched hand mechanism

Mason Classification (Types I-IV)

Often associated with other injuries

Olecranon Fractures

Direct fall onto elbow

Or triceps avulsion mechanism

Mayo Classification

Usually requires surgical fixation

Distal Humerus Fractures

Bimodal: young trauma, elderly falls

Complex intra-articular patterns

AO/OTA Classification

Challenging surgical reconstruction

Classification Systems

Mason Classification - Radial Head Fractures

Type I

Non-displaced or <2mm

Treat: Sling, early motion

Type II

Displaced >2mm, partial head

Treat: ORIF if >30% head

Type III

Comminuted, entire head

Treat: ORIF or replacement

Type IV

Any fracture + dislocation

Treat: Address stability

Mayo Classification - Olecranon Fractures

Type I

Non-displaced

A: Non-comminuted | B: Comminuted

Type II

Displaced, stable

A: Non-comminuted | B: Comminuted

Type III

Unstable (elbow subluxation)

A: Non-comminuted | B: Comminuted

Terrible Triad Injury

The "terrible triad" is a severe injury pattern consisting of:

  • 1. Elbow dislocation (usually posterior)
  • 2. Radial head fracture
  • 3. Coronoid fracture

This injury is inherently unstable and requires surgical treatment addressing all components to restore stability. The lateral collateral ligament is also typically torn.

Treatment Options

Non-Operative Treatment

Suitable for stable, minimally displaced fractures:

Radial Head Type I

Sling comfort, early ROM within 1-2 weeks, aspiration of hemarthrosis may help pain

Olecranon Type IA

Splint at 45-90° flexion, early protected motion if stable

Surgical Treatment

ORIF (Open Reduction Internal Fixation)

Standard treatment for most displaced fractures

  • • Radial head: Headless screws, small plates
  • • Olecranon: Tension band wiring, plate fixation
  • • Distal humerus: Dual plating (parallel or 90-90)

Radial Head Replacement

Indicated when radial head is unrepairable and stability is needed. Metal prosthesis replaces damaged head.

Radial Head Excision

Only in isolated, stable injuries with unrepairable fracture. Contraindicated if elbow unstable or Essex-Lopresti injury.

Total Elbow Replacement

Option for elderly patients with severe distal humerus fractures where ORIF may fail.

Complications & Outcomes

Common Complications

Stiffness (most common)
Post-traumatic arthritis
Heterotopic ossification
Hardware irritation
Nonunion or malunion
Nerve injury (ulnar most common)

Keys to Good Outcome

Anatomic reduction of articular surface
Stable fixation allowing early motion
Early range of motion exercises
Compliance with therapy protocol
Address all components of complex injuries
HO prophylaxis when indicated

Evidence & References

• Mason ML. Some observations on fractures of the head of the radius with a review of 100 cases. Br J Surg 1954

• Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. JBJS Am 1995

• Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. JBJS Am 2002

• McKee MD, et al. A multicenter, prospective, randomized, controlled trial of open reduction-internal fixation versus total elbow arthroplasty. JBJS Am 2009

Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)

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