All You Need To Know About Elbow Fractures in Children
Accounting for about 10% of all childhood fractures, elbow fractures are a common childhood injury. In most cases, a simple fracture heals well with conservative cast treatment. However, certain kinds of elbow fractures may require surgery. This includes those in which the pieces of bone are significantly out of place. In addition, other structures in the elbow, like the ligaments, nerves and blood vessels, may also be injured during the fracture and may require treatment as well.
Which part of the arm does it concern?
There are three bones that make up the elbow joint. They are the humerus, radius and ulna. The humerus is the upper arm bone between the shoulder and elbow. Next is the radius, which is one of the two forearm bones between the elbow and wrist. It is situated on the side of the forearm where the thumb is. Lastly, the ulna is the other forearm bone between the elbow and wrist. It runs next to the radius and is situated on the side of the forearm where the pinky finger is.
The elbow joint is crossed by three major nerves. It is held together by ligaments on the inner and outer sides of the elbow. The joint is also held together by muscles that surround it on the front and back sides.
What are the different kinds of elbow fractures?
Above the elbow (supracondylar)
The most common kind of fracture, this occurs when the upper arm bone (humerus) is broke slightly above the elbow. Typically occurring in children below eight years of age, it is on the severe side as it can result in nerve injury and impaired circulation.
At the elbow knob (condylar)
A condylar fracture occurs through one of the bony knobs, called condyles, at the end of the upper arm bone. Most of these fractures occur through the outer, or lateral, knob. Careful treatment is required for these as they can disrupt both the joint surface and the growth plate (physis).
At the inside of the elbow tip (epicondylar)
The epicondyle is a projection at the top of each bony knob. Fractures at this point usually occur on the inside, or medial, epicondyle in children from 9 to 14 years old.
Growth plate (physis)
The upper arm bone and both forearm bones have areas of cartilage, known as growth plates, near the end of the bone. Growth plates help to determine the length and shape of the mature bone. As such, a fracture that disrupts the growth plate can result in arrested growth or even deformity if not quickly treated.
A fracture can occur at the top (head) of the radius bone, and as a result, cause it to move out of place. Fractures of the tip (olecranon) of the ulna, on the other hand, are rare.
A Monteggia fracture is a fracture of the ulna associated with a dislocation of the top of the radius at the elbow. If the fracture is treated, but the dislocation is not recognised, it can lead to a permanent impairment of the elbow joint function.
An open fracture happens when a broken bone breaks through the skin. Fractures of this kind take a longer time to heal as they may involve damage to the ligaments, tendons and muscles.
What causes elbow fractures in children?
In most cases, elbow fractures in children are caused by a fall on an outstretched arm, or a fall or blow directly on the elbow.
As children are very active, they regularly engage in many activities that put them at risk for injuries to the elbow. A large number of elbow injuries occur on the playground when children lose their grip on the monkey bars or other equipment. As for toddlers, an elbow fracture can be caused by falling from a lower height. An elbow fracture may also occur during recreational activities such as cycling or skateboarding or sports such as football or gymnastics.
To lower the risk of an elbow fracture, one could wear protective elbow pads and guards.
What are the symptoms of elbow fractures in children?
Some common symptoms of elbow fractures in children include:
- Sudden and intense pain in the elbow and forearm
- Swelling around the elbow
- Inability to straighten the arm
- Numbness and tingling in the hand or forearm, which is a sign of potential nerve injury
- Visible deformity
If a child complains of pain in the elbow after a fall and refuses or is unable to move their arm, it is crucial to visit a doctor right away.
How is a doctor evaluation carried out?
First, the child’s symptoms and medical history will be discussed. Next, a careful examination of the arm will be performed to determine the extent of the injury. The doctor will look out for swelling, bruising, tenderness, limited movement. They will also examine for a change of colour in the hand, which is an indication that circulation has been affected. On top of that, they will check for any injury to the blood vessels or nerves.
X-rays are able to provide clear images of dense structures such as bone. Performing an X-ray can indicate what kind of fracture has occurred and whether the bones have angulated or been displaced. Because a child’s bones are still developing, X-rays of both arms may be requested for comparison.
How are elbow fractures in children treated?
If an elbow fracture heals in the wrong position, the elbow may be permanently distorted and have a limited range of motion. As such, it is crucial that the fracture is treated correctly during the initial injury.
To determine the appropriate treatment for elbow fractures, the kind of fracture and the degree of displacement must be considered.
Cast or splint immobilization has been known to produce a high success rate of healing in stable fractures. Thus, if the fracture is stable with no displacement, a splint or cast may be applied directly to keep the bones in proper alignment as they heal.
Although splints provide less support than casts, they are easily adjustable to accommodate swelling from injuries. In numerous cases, a splint is first applied to a fresh injury. As time passes and the swelling subsides, it may then be replaced with a full cast.
In certain stable elbow fractures, the bones may need some repositioning before a splint or cast can be applied. A procedure, called a closed reduction, will be performed to gently move the arm to manipulate the bones back into place. During this procedure, the child will be given some form of anaesthesia or sedation.
In addition, several X-rays may be scheduled to ensure the bones stay in the right position as they heal.
In cases where the bone fragments are displaced, surgery may be required to make sure the fracture heals totally.
Closed reduction and percutaneous pinning
In this procedure, the displaced bone fragments are repositioned during close reduction and held in position using metal pins. These pins are inserted through the skin, into the bone and across the fracture. A splint is be applied to protect the area for the first week. Afterwards, it will usually be replaced with a cast. After healing has begun, the pins and cast will be removed. This is typically done a few weeks after the procedure.
Open reduction and internal fixation
Certain kinds of fractures require open surgery or open reduction and internal fixation. These include open fractures, fractures that cannot be repositioned during a closed reduction and fractures that are accompanied by nerve or vascular injuries.
What does the recovery process of elbow fractures in children look like?
Whether the fracture has been treated via simple immobilization or surgery, the arm will be placed in a splint or cast for 3 to 6 weeks. How long it has to be placed in the splint or cast is dependent on the fracture.
Once the fracture has healed well enough, the doctor may recommend certain exercises to improve the range of motion in the joint.
In the majority of cases, the range of motion in the elbow will return to normal or just be limited mildly.