Types of Elbow Fractures in Children

Broken elbows are common injuries in children. Many activities kids participate in making their elbows vulnerable to injury. Furthermore, there are several growth plates (areas of bone that are actively growing) around the elbow joint. These growth plates are susceptible to injury. Children who have elbow injuries should be evaluated by a healthcare provider for a fracture.

Many activities can cause elbow fractures in children, but jungle gyms are a large culprit. Kids falling from jungle gyms can injure their elbows as they fall to the ground. Other common activities that cause elbow injuries include gymnastics, football, jumping on beds, and rough play.

When a Child Should See a Healthcare Provider About an Elbow Injury

If you are unsure of the diagnosis it is always safest to have your child seen by their pediatrician or in the emergency room. Signs that should tip you off to a problem include:

• Inability to straighten or bend the elbow
• Swelling or discoloration (bruising) around the elbow
• Pain around the elbow joint

Diagnosis

Your healthcare provider will first evaluate your child's arm for signs of damage to the nerves and blood vessels around the elbow joint. While damage to these structures is uncommon, it is important to know if there is a problem. Injuries to the blood supply of the arm may necessitate early surgical intervention.

X-rays are used to diagnose elbow fractures. In more severe injuries, the fracture will be easily seen on X-ray, but it is not uncommon to have some types of elbow fractures that do not show up on X-ray.

The reason is that growth plate fractures may not show up on an X-ray like normal broken bones. Therefore, your healthcare provider may request an X-ray of the opposite elbow (your child's uninjured side) to compare the two for differences. Often the only sign of a broken elbow in a child is swelling seen on X-ray (the so-called 'fat-pad sign'). In this case, the elbow should be treated as having a break.

Types of Elbow Fractures

Some common types of elbow fractures include:

• Supracondylar Humerus Fracture: The supracondylar fractures are the most common type of elbow fracture. They occur through the growth plate of the humerus (above the elbow joint). The most common cause of these injuries is a fall onto an outstretched arm--often a jungle gym. These injuries most commonly occur in children between the ages of 5 and 7 years old.
• Condylar Fractures: Condylar fractures also occur just above the elbow joint. When a child sustains a condylar fracture, they have broken one side of the elbow joint.
• Radial Neck Fractures: The treatment of a radial neck fracture depends on the angulation of the fracture. Treatment may consist of casting, manipulation, or possibly placing pins across the fracture.
• Radial Head Subluxation: While not a broken bone, a radial head subluxation is a common injury in a young child's elbow. When a radial head subluxation occurs, the elbow joint slides out of position. These injuries need to be placed back into position with manipulation or surgery.
• Olecranon Fractures: Olecranon fractures are injuries to the prominent bone at the back of the elbow. Injuries to this bone can be difficult to differentiate from normal growth plate appearances, so X-rays of both elbows may be obtained for comparison.

Treatments

Treatment of elbow fractures depends on several factors including:

• Location of the fracture
• Amount of displacement of the fracture
• Age of the patient
• Damage to nerves and blood vessels

Splints: Splinting is the treatment for many elbow fractures, especially those that have minimal displacement (are not out of place). A splint is also commonly used when there is suspicion of an elbow fracture even when there are normal X-rays.

• In the case of normal X-rays, a splint will be placed and your child will have new X-rays about a week after injury. The repeat X-rays may show signs of healing of the fracture.

Casts: Casts are often used to treat elbow fractures, but not after the initial injury. More commonly the elbow will be splinted for a week, and a cast may be placed after the swelling has had time to subside.

Surgery: Surgical options include:

• Pins: Pins are often used to stabilize the fracture after it has been placed in a proper position. The pins are placed by an orthopedic surgeon with your child under general anesthesia. A small incision may be made to reposition the fracture and to protect the nerves around the elbow joint during pin placement. The pins hold the fracture in proper position until sufficient healing has taken place, usually about three to six weeks.
• Screws: In older children, sometimes a screw is used to hold the fracture in the proper position. Pins are usually used in younger children, but in children who are approaching skeletal maturity, a screw and sometimes a plate may be used instead.

Long-Term Complications

Because the fractures are often around the growth plate, there is always a chance of injury to the growth plate. This may cause early closure of the growth plate. This is uncommon, and the only way to tell if the growth plate is permanently injured is for the orthopaedic surgeon to monitor to the child's limb growth over time.

Other potential complications include restriction of motion of the elbow joint, damage to nerves and blood vessels around the elbow, and infection of the pins that are placed into the elbow.

Complications are unusual, but they do occur in a small percentage of patients. Your healthcare provider will follow your child until fracture healing is complete, and they may ask for a follow-up to ensure growth and motion around the elbow are normal. Be sure to learn about warning signs and alert the healthcare provider if there is suspicion of a problem after a fracture.