What is the treatment for an avulsion fracture of the elbow?

Treatment of Avulsion Fractures of the Elbow

Avulsion fractures of the elbow should be treated with splinting in the position found, unless straightening is necessary for safe transport to a medical facility, followed by appropriate orthopedic referral for definitive management. 1

Initial Assessment and Management

• Radiographic evaluation: Standard radiographs (anteroposterior, lateral, and mortise views) are usually appropriate as the initial imaging for acute elbow pain 1
• Signs requiring immediate attention:
  • If the fractured extremity appears blue, purple, or pale (indicating poor perfusion)
  • If there is an open wound with severe bleeding
  • In these cases, activate emergency response system immediately 1

Treatment Approach Based on Fracture Type

Conservative Management

• Indicated for avulsion fractures with:
  • Less than 9 mm displacement
  • Maximum bone fragment diameter of 13 mm or less
  • Stable joint 2
• Management includes:
  • Splinting the fractured extremity in the position found 1
  • Covering open wounds with clean dressing to prevent contamination 1
  • Early finger motion exercises to prevent edema and stiffness 3

Surgical Management

• Indicated for avulsion fractures with:
  • Displacement greater than 9 mm
  • Unstable joint
  • Significant internal joint derangements 2
• Common surgical approaches:
  • For triceps avulsion: Repair with bone suture anchors 4
  • For epicondyle avulsions: Internal fixation for large fragments or when associated with instability 5

Specific Avulsion Fracture Types

Medial Epicondyle Avulsion

• Rare in adults but may occur with elbow dislocations
• May require hinged bracing followed by physical therapy 6
• Conservative treatment can be selected if displacement is 9 mm or less 2

Triceps Avulsion

• Rare injury characterized by inability to extend elbow against gravity
• May show "flake sign" on lateral radiographs (flecks of avulsed bone from olecranon) 4
• Often requires surgical repair with bone suture anchors
• Post-repair immobilization in neutral position for 2-4 weeks 7

Complex Avulsion Fracture-Dislocations

• Require careful assessment of overall injury pattern
• Trans-olecranon fracture-dislocations: Surgical treatment with anatomic restoration of trochlear notch
• "Terrible triad" injuries (posterolateral elbow dislocation with radial head and coronoid fractures): Usually require surgical repair 5

Rehabilitation Protocol

• Begin weaning from brace according to stability and healing progress
• Implement home exercise program focusing on active and passive range of motion exercises
• Schedule follow-up with new x-rays in 3 months 3
• Early finger motion is essential to prevent edema and stiffness 3

Common Pitfalls to Avoid

• Failure to identify associated soft tissue injuries that may require specific treatment
• Inadequate immobilization leading to displacement of fracture fragments
• Overly aggressive early mobilization in unstable fractures
• Delayed mobilization leading to stiffness and reduced functional outcomes
• Not recognizing signs of poor perfusion requiring immediate medical attention 1

Remember that avulsion fractures in adults are relatively uncommon and may be associated with significant soft tissue injuries. The treatment approach should be guided by fracture characteristics, joint stability, and the presence of associated injuries.