Overview
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
The elbow joint is composed of three bones that interact to enable bending, straightening, and rotating the forearm:
- Humerus: The upper arm bone extending from the shoulder to the elbow.
- Radius: The forearm bone on the thumb side that allows wrist rotation.
- Ulna: The forearm bone on the pinky side that functions as a hinge for elbow movement.
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 deformity, swelling, acute pain, inability to move the elbow, and bruising. Severe cases may also present with numbness or tingling in the hand or forearm. Seek immediate medical attention if these symptoms are present.
Diagnosis & Treatment
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.TreatmentTreatment varies based on the fracture type and severity:Nonsurgical
Treatment
For fractures with relatively good alignment, treatment usually involves a cast or splint for about a month. Follow-up x-rays may be needed to ensure the bones remain in place.Surgical Treatment: If alignment is poor, surgery may be required to realign the bones using pins, screws, or wires, often followed by casting or splinting for additional protection. Surgical hardware is typically removed once the bone heals sufficiently.
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.
Common Injuries
Age Recommendations
Reducing Risk
Application & Aftercare
Managing the Cast
Cast Removal
How does it occur?
Return to Sport
Prevention
Home Exercises
