Fractures around the elbow are common injuries in children. In fact, 1 out of every 10 fractures in children occur around the elbow joint.
These fractures usually occur when the child falls over and puts out their hand to brace themselves. Elbow fractures particularly occur then a child falls from a height, such as from monkey bars or trampolines.
Types of Fractures
Around the elbow, there are a number of places a children can break the bone.
Above the elbow (supracondylar)
When the humerus (upper arm bone) is broken just above the elbow joint, it is called a supracondylar fracture.
These fractures usually occur in children younger than 8 years of age.
This is the most common elbow fracture, and can be very serious if it involves nerve damage or impairs the blood circulation to the arm.
At the elbow knob (condylar):
This type of fracture occurs through one of the bony knobs (condyles) at the end of the upper arm bone (humerus). Most occur through the outer (lateral) knob. These fractures require careful treatment, because they can disrupt both the growth plate (physis) and the joint surface.
At the inside of the elbow tip (epicondylar):
At the top of each bony knob is a projection called the epicondyle. Fractures at this point usually occur on the inside (medial) epicondyle in children between 9 and 14 years of age.
Growth plate (Physis):
The upper arm bone and both forearm bones have growth plates located near the end of the bone. A fracture that disrupts the growth plate (physis) can result in arrested growth and/or deformity.
Symptoms
Regardless of where the break is, the symptoms of a broken elbow are similar.
- Acute pain
- Tenderness
- Swelling (may be severe or mild)
- Limited movement
Causes
Supracondylar fractures – these are caused by falling on an outstretched arm
Condylar fractures – these are caused by either falling on an outstretched arm, or falling directly onto the tip of the elbow
Epicondylar fractures – these are caused by falling on an outstretched arm
Physis fractures – these may be caused by birth trauma, or by direct trauma
Risk Factors
If the child is an active athlete, make sure that he or she wears the proper protective equipment. Elbow guards and pads can help reduce the risk of a fracture about the elbow.
Investigations
If a child complains of elbow pain after a fall and refuses to straighten his or her arm, see a doctor immediately. The doctor will first check to see whether there is any damage to the nerves or blood vessels. X-rays will help determine what kind of fracture occurred and whether the bones moved out of place. Because a child’s bones are still forming, the doctor may request X-rays of both arms for comparison.
Complications
- Damage to blood vessels – the major artery bringing blood to the arm passes near the elbow joint and is endangered by fractures at the elbow.
- Damage to nerves – nerves supplying the forearm and hand with sensation and movement pass near the elbow joint. They can be damaged with fractures at the elbow. This may result in pain, tingling, numbness or weakness in the forearm or hand.
- Damage to muscles – if the blood supply to the forearm and hand is compromised for a period of hours, the muscles may be permanently damaged resulting in long term weakness of the forearm, wrist and hand.
- Deformity – if the ends of the fracture heal in an abnormal way, the forearm may be at an abnormal angle to the upper arm.
Treatment
Treatment depends on the type of fracture and the degree of displacement. If there is little or no displacement, the doctor may immobilise the arm in a cast or splint for 3 to 5 weeks. During this time, another set of X-rays may be needed to determine whether the bones are staying properly aligned. If the fracture forced the bones out of alignment, the doctor will have to manipulate them back into place. Sometimes, this can be done without surgery, but more often, surgery will be needed. Pins, screws, or wires are used to hold the bones in place. The child will have to wear a cast for several weeks before the pins are removed. Range of motion exercises can usually begin about a month after surgery.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
If the child is an active athlete, make sure that he or she wears the proper protective equipment. Elbow guards and pads can help reduce the risk of a fracture about the elbow.