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Health condition · Clinically reviewed

Elbow fracture, patterns, surgery and getting movement back.

From radial head to terrible triad. UK-aligned care, careful neurovascular checks, and specialist upper limb reconstruction where it counts.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BOAST, BOA and peer-reviewed orthopaedic sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK trauma pathways including terrible triad reconstruction and specialist upper limb care.

Key facts

Elbow fracture at a glance.

The essentials, in plain English - the common patterns, the neurovascular risks and the standards that shape UK care.

  • What it is

    A break in one or more of the three bones that meet at the elbow - distal humerus, olecranon, radial head or coronoid process.

  • Common patterns

    Adults: radial head, olecranon, distal humerus, terrible triad. Children: supracondylar humeral, lateral condyle, medial epicondyle.

  • Neurovascular risk

    The median, radial and ulnar nerves and the brachial artery all cross the elbow - a documented check of pulse, capillary refill and all three nerves is critical.

  • Imaging

    AP, lateral and oblique X-ray first. CT for intra-articular and complex patterns; MRI when soft tissue or ligament injury is suspected.

  • Guiding standards

    Managed to BOAST and BOA guidelines - open fractures follow BOAST 4 with urgent antibiotics, tetanus and theatre.

  • The main risk

    Stiffness is the dominant long-term complication - early controlled mobilisation and specialist elbow physiotherapy are essential.

Why this guide matters

Pattern first, then a plan.

The elbow is a small, unforgiving joint. The three ideas below shape everything that follows - and every good outcome.

  • Pattern determines treatment

    Radial head, olecranon, distal humerus, coronoid and terrible triad each need a different plan - the classification (Mason, Regan-Morrey, Gartland) drives the operation.

  • Nerves and vessels come first

    The median, radial and ulnar nerves and the brachial artery all cross the elbow - a careful, documented neurovascular check protects the limb.

  • Stiffness is the enemy

    Early controlled mobilisation and specialist elbow physiotherapy prevent the biggest long-term problem - loss of range of movement.

How the diagnosis is made

From injury to a clear plan.

The steps a UK emergency and orthopaedic team will follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and mechanism

    Fall onto outstretched hand, direct blow, twisting injury or high-energy trauma - plus previous injury, hand dominance and function.

  2. 02

    Assessing

    Focused examination

    Deformity, swelling, skin integrity, open wounds, associated wrist or shoulder injury and compartments.

  3. 03

    Assessing

    Neurovascular assessment

    Radial and ulnar pulses, capillary refill, and median, radial and ulnar nerve motor and sensory function - documented before and after any reduction.

  4. 04

    Confirming

    X-ray AP, lateral and oblique

    The first-line imaging for every suspected elbow fracture - joint effusion (fat pad sign) can be the only clue in occult injury.

  5. 05

    Confirming

    CT for complex and intra-articular

    For distal humerus, coronoid, complex radial head and pre-operative planning - defines fragment size and articular step-off.

  6. 06

    Confirming

    MRI - selective use

    For occult fractures, soft-tissue injury, ligament rupture (LCL, MCL) and cartilage damage where surgical planning depends on it.

  7. 07

    Preparing

    Specialist referral

    Orthopaedic trauma review as an emergency - complex, intra-articular or paediatric patterns to a specialist upper limb service.

Typical pathway: from injury to definitive plan within hours in a UK trauma setting.

Symptoms

What an elbow fracture looks like.

Pain, swelling, deformity and a reluctance to move the arm - plus the features that mean it is time to move fast.

  • Pain and swelling

    Immediate, severe pain around the elbow with rapid swelling - often with a visible haematoma or effusion.

  • Deformity

    Obvious angulation or step in the bony contour - especially with displaced supracondylar or olecranon fractures.

  • Reduced range of movement

    Refusal or inability to bend, straighten or rotate the forearm - a classic sign of intra-articular involvement.

  • Bruising and skin compromise

    Any tenting of skin over a fragment, blistering or open wound - a surgical emergency needing early theatre.

  • Neurovascular symptoms

    Numb fingers, weak thumb, cold hand, absent pulse or worsening pain in the forearm - warns of nerve, arterial or compartment injury.

  • Terrible triad presentation

    High-energy dislocation with a radial head and coronoid fracture plus PLC injury - unstable, painful, needs specialist reconstruction.

  • Paediatric supracondylar pattern

    A child, falling on an outstretched hand, unable to move the elbow - Gartland II or III needs prompt orthopaedic care.

  • Red flag - open fracture or vascular

    Bone through skin, absent radial pulse, pale cold hand or a tense swollen forearm - urgent theatre and vascular input.

Treatment

How elbow fractures are treated in the UK.

From cast and early movement for undisplaced patterns, through ORIF and radial head replacement, to full terrible triad reconstruction - matched to the injury.

  • Emergency stabilisation

    Analgesia, gentle reduction of gross deformity, above-elbow splint at 90 degrees, neurovascular monitoring and admission for trauma review.

  • Cast or splint - undisplaced

    Mason I radial head, undisplaced olecranon and Gartland I supracondylar patterns - a short period of splintage and early mobilisation.

  • ORIF distal humerus

    Open reduction and internal fixation with parallel or perpendicular plates - specialist upper limb surgery for intra-articular fragments.

  • Total elbow replacement

    For low-demand elderly patients with unreconstructable comminuted distal humeral fractures - see the /treatments/total-elbow-replacement/ guide.

  • Olecranon fixation

    Tension band wiring, plate fixation, or fragment excision in selected cases - restores triceps pull and elbow extension.

  • Radial head fixation or replacement

    ORIF for Mason II and III patterns; radial head replacement (arthroplasty) for Mason IV, comminuted heads and the terrible triad.

  • Terrible triad reconstruction

    Coronoid ORIF, radial head fixation or replacement, LCL and PLC repair, hinged external fixation in selected cases - specialist upper limb only.

  • Paediatric supracondylar surgery

    Gartland II and III patterns: closed reduction and percutaneous K-wiring, occasionally open reduction - specialist paediatric orthopaedic care.

Post-operative care

Early controlled mobilisation is the key to a moving elbow.

Whichever operation is done, the plan afterwards is the same in spirit - protected but active. A specialist elbow physiotherapist guides range, strength and confidence, and a wider MDT of trauma, upper limb, physio, occupational therapy and pain services supports recovery for complex cases. Complications to watch for include stiffness, heterotopic ossification, ulnar nerve neuropathy (see cubital tunnel syndrome), non-union, malunion, post-traumatic arthritis and complex regional pain syndrome (see CRPS).

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your orthopaedic surgeon knows your fracture pattern and your imaging. If in doubt, get seen.

  • British Orthopaedic Association (BOA) and BOAST - Open Fractures (BOAST 4) and BOAST - Peripheral Nerve Injury.

  • BOA - Management of Supracondylar Humeral Fractures in Children (BOAST paediatric).

  • NICE. NG38 Fractures (complex) - assessment and management.

  • Royal College of Emergency Medicine. Best practice guidance on limb trauma and neurovascular assessment.

Red flags

When an elbow injury is an emergency.

Most elbow fractures are managed on a trauma pathway. These are the situations that need same-hour attention.

  • Open fracture

    Any bone-through-skin or contamination needs BOAST 4 care - IV antibiotics within an hour, tetanus, photograph, saline dressing and urgent theatre.

  • Absent or diminished radial pulse

    A pale, cold, pulseless hand after a supracondylar or distal humeral fracture is a vascular emergency - urgent reduction and exploration.

  • Compartment syndrome

    Disproportionate pain, pain on passive finger extension, tense forearm or paraesthesia - urgent fasciotomy to save the limb.

  • Progressive neurological deficit

    Worsening median, radial or ulnar function after injury or reduction - needs urgent surgical exploration.

  • Skin tenting or blistering

    A displaced fragment threatening to break through the skin is a surgical emergency - do not wait for the wound to open.

  • Terrible triad and dislocation

    A dislocated elbow with radial head and coronoid fractures is inherently unstable - reduce, splint and refer to a specialist upper limb service.

  • Paediatric red flags

    A child with a swollen, painful elbow after a fall onto an outstretched hand needs same-day orthopaedic review - occult supracondylar and lateral condyle fractures are easy to miss.

  • Suspicion of non-accidental injury

    Elbow fractures in non-mobile children, or a story that does not fit, need safeguarding input alongside orthopaedic care.

  • Late presentation with deformity

    A missed or malunited paediatric fracture with cubitus varus or valgus deserves specialist paediatric orthopaedic review.

Recovery

A moving elbow, step by careful step.

Four things that make the biggest difference to how much movement you get back - safe early motion, expert physiotherapy, patience with the timeline and speaking up early.

A quiet reminder

The elbow rewards early motion.

Prolonged immobilisation is the enemy of a functional elbow. Work with your surgeon and therapist on the safe window.

  1. 01 Move

    Start moving early - safely

    Once the surgeon says so, controlled movement is the single most important thing you can do to prevent stiffness.

  2. 02 Therapy

    Work with a specialist physiotherapist

    Elbow rehabilitation is a specialised skill - a hand and upper limb therapist knows exactly how far to push, and when.

  3. 03 Patience

    Expect months, not weeks

    Full range and confidence often take three to six months, sometimes longer after complex reconstruction - progress is not linear.

  4. 04 Escalate

    Speak up early about stiffness or pain

    Persistent stiffness, ulnar nerve symptoms or unexplained pain deserve early review - many complications are easier to treat sooner rather than later.

Frequently asked

Everything we get asked about elbow fractures.

Quick answers on patterns, imaging, surgery and recovery.

  • What is an elbow fracture?

    A break in one or more of the three bones that meet at the elbow - the distal humerus, the olecranon (proximal ulna) or the radial head. Common patterns include radial head fractures, olecranon fractures, distal humeral fractures, coronoid fractures, and complex injuries such as the terrible triad, Monteggia and Essex-Lopresti. In children, supracondylar humeral fractures are the most common.

  • How is an elbow fracture diagnosed?

    Assessment begins with the history and mechanism, followed by a focused examination for deformity, skin integrity and neurovascular status - documenting the median, radial and ulnar nerves and the radial pulse. AP, lateral and oblique X-rays are first-line; CT is used for intra-articular and complex patterns and pre-operative planning; MRI is reserved for occult fractures and soft-tissue or ligament injury.

  • What is the terrible triad of the elbow?

    A high-energy injury pattern combining a posterior elbow dislocation with a radial head fracture, a coronoid process fracture and a lateral collateral ligament (posterolateral corner) injury. It is inherently unstable and typically needs specialist upper limb surgery to fix or replace the radial head, fix the coronoid, repair the lateral ligament complex, and occasionally apply a hinged external fixator.

  • Do all elbow fractures need surgery?

    No. Undisplaced Mason I radial head fractures, undisplaced olecranon fractures and Gartland I paediatric supracondylar fractures are usually managed non-operatively with a short period of splinting and early controlled mobilisation. Displaced, intra-articular, unstable or open fractures generally need surgical fixation or replacement.

  • What are the main complications after an elbow fracture?

    Stiffness is the single most important complication - loss of range is common and directly affects daily function. Others include heterotopic ossification, ulnar nerve neuropathy (see /conditions/cubital-tunnel-syndrome/), non-union, malunion, post-traumatic arthritis and complex regional pain syndrome (see /conditions/crps-complex-regional-pain-syndrome/). Early controlled mobilisation and specialist elbow physiotherapy reduce these risks substantially.

  • How long does it take to recover from an elbow fracture?

    Simple, undisplaced fractures often settle within six to eight weeks, though full confidence takes longer. After surgical fixation - and particularly after complex reconstructions such as the terrible triad - most patients need three to six months to regain useful range, and stiffness may continue to improve for a year. Recovery depends heavily on the pattern, the operation and the quality of rehabilitation.

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