Elbow Fractures

About Elbow Fractures

Children are naturally active, which increases the risk of falls that can lead to fractures, particularly around the elbow. If a child falls with significant force, the bone around the elbow can break. Elbow fractures are quite common, accounting for about 10% of all fractures in children.

Anatomy

Types

There are several types of common elbow fractures:

• Occult Elbow Fractures: Common in growing children, these fractures may not be immediately visible on x-rays. They often present with swelling and pain, but later x-rays typically show healing bone. These fractures are generally treated with splints or casts and heal rapidly with improved comfort.
• Supracondylar Fracture: This occurs in the humerus just above the elbow and is the most frequent elbow fracture in children. Severe cases may require urgent surgery.
• Condylar Fracture: This type involves the joint surface of the humerus above the elbow, typically affecting the outer part of the elbow. Proper alignment of the joint surface is crucial, and these fractures may require a longer casting period and close monitoring due to potential healing issues.
• Epicondylar Fracture: Found at the bony prominences on either side of the elbow (medial or lateral). Medial epicondyle fractures can result from overuse or dislocations and may require specific attention.
• Physeal Fractures: These fractures affect the growth plate in the humerus, radius, or ulna. Improper treatment can lead to growth issues in the affected bone.
• Monteggia Fracture: Characterized by an ulna fracture and dislocation of the radial head. This injury often causes significant pain and swelling and may be diagnosed through physical examination and x-rays.

Symptoms

Signs of an elbow fracture include:

Causes

Most elbow fractures occur when a child falls on an outstretched arm with a lot of force from the fall. This impact can cause a fracture or break near the elbow.

Diagnosis

• Examination: A doctor will assess the skin around the elbow, forearm, and wrist, and may gently move the joints to identify pain. Testing for nerve function and circulation is also crucial.
• Other Tests: X-rays are typically sufficient for diagnosing elbow fractures. If fractures are suspected in the forearm or if x-rays are inconclusive, additional imaging such as MRI, ultrasound, or arthrogram may be needed.

Treatment

Treatment varies based on the fracture type and severity:

Outcomes

Post-cast or post-surgery, some stiffness in the elbow or wrist is common but often resolves with time. Physical therapy may be needed to regain full motion. If fractures heal well and bones are properly aligned, the long-term outcome is generally excellent. Prompt medical attention can prevent complications such as improper healing or loss of motion.