Kid's Elbow Fracture
Elbow fractures in kids are common injuries. Over 10% of all childhood fractures occur around the elbow. The elbow joint is made up of three bones, the 1) humerus, 2) radius and 3) ulna. The humerus bone is the bone in the upper arm that extends from the shoulder to the elbow. The forearm consists of the radius and ulna bones, which extend from the elbow to the wrist. The radius (along the thumb side of the forearm) and ulna (pinkie side) allow for normal forearm rotation, in addition to normal wrist and elbow motion. Fractures around the elbow can involve any of these bones, or a combination.
Causes
Elbow fractures in kids usually result from a fall onto an outstretched arm, or a fall directly onto the elbow. Monkey bars, playground equipment, scooters, bikes, and sports are common culprits, as they produce higher energy falls that can cause the bone to break.
Diagnosis
Elbow fractures result in pain, swelling, and decreased motion. Kids will oftentimes have difficulty bending or straightening the elbow, or pain or difficulty rotating the forearm. More severe elbow injuries can numbness in the hand or fingers.
X-rays are essential for a diagnosis, but they can be challenging to interpret for the untrained eye. There are several ossification centers, or “growth plates” around the elbow, which can have different appearances based on the age of the child. These growth plates can sometimes mimic fractures, or fractures can occur through them.
Treatment
Non-surgical treatment
Non-displaced, or stable, fractures can oftentimes be treated in a splint or cast. Splints provide less support than a hard cast, but they allow for more swelling. If placed initially, these are oftentimes changed to a circumferential cast once swelling subsides. Fractures take ~6 weeks to heal, but this can vary based on the location, severity, and age of the child.
Surgery
Fractures that have shifted, or “displaced”, are sometimes treated surgically. This can involve reducing, or “setting” the bone, which can then be held in a corrected position with either pins or a cast. Sometimes an incision is required to properly align the fracture.
A common elbow fracture in kids is a “supracondylar humerus fracture”. This occurs following a fall onto an outstretched hand. These are diagnosed with an x-ray. Fractures that have bent the bone, or displaced it, may require a small outpatient procedure to re-align the humerus bone.
Lateral (side) x-rays of an elbow in a child. These show an angulated, or displaced, supracondylar humerus fracture. With this degree of angulation, surgery is usually recommended.
X-rays (lateral and AP) of a supracondylar humerus fractured treated with a reduction (setting of the bone), with placement of pins through the skin to hold the bone in proper alignment. A cast is placed for ~3 weeks, and the pins are removed in the office.
Supracondylar humerus fracture that was successfully treated with a reduction and pinning. The bone has healed in a normal position, and activities are restarted as tolerated.
Another fracture seen in children around the elbow is a medial epicondyle avulsion fracture. The medial epicondyle is a bone along the inside of the elbow which serves as the insertion site for all of the muscles that flex the wrist and fingers. It is also the attachment site for the medial collateral ligament, which helps stabilize the elbow. Displaced fractures are oftentimes surgically treated to restore function of these muscles and ligaments.
Medial epicondyle avulsion fracture. This fracture was notably displaced (shifted) and was incarcerated or trapped inside the elbow joint. The fracture piece was restored to its normal position and held in place with a metal screw.
“We started with Dr. Schreiber a year ago when my then 6 year old suffered a level 3 break of her elbow and needed surgery. She suffered nerve issues on top of the break. He was with us every step of the way through the healing process. He even called to talk me through the recovery process and what to expect and calm my mommy anxiety. We left our year later appointment today and my daughter said “I will miss Dr. Schreiber, he has been such a good Dr. to me” and that warms my mother heart. We never want our child to be injured or need surgery, but I’m thankful we ended up in his hands throughout this process.”
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.