Children can be daredevils. Even when they’re appropriately equipped and supervised, it’s natural for kids to underestimate the dangers of physical activities. Playground activities, sports, and roughhousing all carry real risks.
Accidents usually amount to little more than a bad surprise and a little bruise. But because children’s bones are always growing, even moderately serious injuries may indicate fractures requiring special care. This is especially true of the elbow joint, which contains several growth plates. It often takes the brunt of a fall.
The elbow joint is complex, and so is the nature of elbow fractures. A rough tackle on the football field invites a different injury. It differs from one incurred after a fall from an 8-foot jungle gym. Before we look at treatment options for various kinds of elbow fracture, let’s look at the types of fracture themselves.
Kinds of elbow fracture
Humerus fractures are the most common elbow fractures among children aged 5 to 7. The humerus is the large upper-arm bone whose bottom end forms the top of the elbow joint. When you bump your funny bone, you’re actually rubbing your ulnar nerve against the humerus. When children fall from large heights — such as slipping off monkey bars — and land with outstretched arms. In these cases, the humerus often hits the ground first.
Humerus fractures may involve the entire growth plate above the elbow joint or just one side of the plate. These are called supracondylar and condylar humerus fractures, respectively.
Elbow fractures involving the radius, one of the two lower arm bones, are less common. The head, or knobby end of the radius that forms part of the elbow joint, isn’t often fractured. However, it is especially susceptible to displacement, or subluxation. While dramatic, displacement is easily treated by sliding the joint back into position.
Beneath the radius’ head lies a thinner stretch of bone, the neck. The radial neck can fracture in many different ways. Therefore, careful diagnosis is essential to providing the right treatment.
The final category of elbow fracture involves the other forearm bone, the ulna. When your elbow is bent the ulna forms its prominent bony point. This is called the olecranon. This is a tough piece of bone, and a fast-growing one in children; olecranon fractures can be hard to distinguish from the effects of normal bone growth.
When to see a doctor
If you suspect that your child has fractured or otherwise seriously injured an elbow, consult an orthopaedic. That said, some children bounce back faster after a fall. The symptoms of an elbow fracture may appear over hours or days. Here’s what to look for.
Lingering elbow pain. Follow up with your child over the days after an injury. Ask about any lingering pain, especially if your child tends to be stoic.
Problems with movement. Also be sure to ask your child to move the injured elbow through its full range of motion. If that proves impossible, it’s time to see a doctor.
Bruising and/or swelling around the elbow. Remember, only relatively few elbow fractures appear on the joint’s bony protrusions: Bruising and swelling may appear a few inches away from the centre of the joint itself.
Diagnosis
Paediatricians often look for signs of serious problems first. Your doctor will likely examine your child’s elbow for signs of nerve damage and interruption of the joint’s blood supply. These symptoms are rare, but they do occur, and the sooner they’re identified, the sooner your child can have the necessary surgery.
Once the direst possibilities are eliminated, your doctor will likely take a series of x-rays to identify exactly how your child’s elbow was impacted. Some fractures can be hard to spot, even on an x-ray image. Your child’s entire skeleton is constantly growing This can make it difficult for even an experienced doctor to tell an abnormality from the normal appearance of a growing bone plate. Your doctor might order x-rays of your child’s healthy elbow as a point of comparison.
Treatment
Your child’s elbow fracture will be treated in one of two ways: by stabilization or by surgery. Each involves a number of options, and the right therapy depends on a number of factors, including
- The child’s age and level of physical development
- The fracture’s location
- The fracture’s severity, including any displacement
- Damage to surrounding nerves and blood vessels
Non-Surgical Treatment
Stabilization is the most common treatment for childhood elbow fractures. This usually involves a simple splint, worn to keep the joint still while the fracture heals and swelling subsides. Your doctor will probably invite you back in a week or so for another round of x-rays to confirm that everything is healing as it should.
Once the swelling has gone, your child’s elbow will likely be put in a cast. This gives the elbow its best chance to heal quickly and allows your child to resume as much normal activity as possible. Until then, parents should take extra care of their child.
Surgery involves the insertion of pins or screws to stabilize troublesome fractures while they heal. When necessary, your orthopaedic surgeon will also reposition fractured bones and take whatever steps are necessary to help blood vessels regenerate around the injured area and to protect any nerves that might be affected.
Pins are usually recommended for younger children with faster-growing bones. They are usually removed after three to six weeks after the fracture has healed.
Screws may be recommended as a more secure option, especially for older children whose bones are not growing as rapidly. They accomplish the same thing as pins, and in most cases are also removed after the fracture has healed.
While these surgeries are routine, any surgery invites the possibility of long-term complications. The same risk of infection and incomplete recovery that applies to any surgery for any patient applies here. In rare cases, blood vessels may be damaged and prevented from regenerating. Secondary factors like internal bleeding or swelling may affect nerves passing through the elbow.
Because children’s bones grow so quickly and steadily, severe elbow fractures may affect future bone growth by disturbing a bone’s growth plate. This occurs rarely, and cannot be immediately diagnosed: only regular monitoring can tell doctors whether additional steps are needed to address risks to future bone growth.
Elbow Fracture Recovery: What to Expect
Recovery time varies by fracture type and severity. Simple supracondylar fractures managed with a cast typically heal within three to four weeks in young children. More complex fractures requiring surgery may take six to eight weeks before the cast or splint is removed, followed by physiotherapy to restore range of motion. The elbow is particularly prone to stiffness after immobilisation, so early, gentle movement once the bone is healed is important.
Your orthopaedic surgeon will take follow-up x-rays to confirm the bone is healing in correct alignment. The carrying angle of the elbow — the slight outward angle of the forearm when the arm is straight — should be preserved. Malunion in this area can cause a permanent deformity called cubitus varus or cubitus valgus, which in some cases requires corrective surgery years later. Careful initial alignment reduces this risk significantly.
Complications to Watch For
Most elbow fractures in children heal without complications. However, parents should watch for a few warning signs during recovery. Increased pain inside the cast, numbness or tingling in the fingers, or a cold pale hand may indicate vascular compression — this requires immediate medical attention. After cast removal, persistent stiffness, weakness of grip, or a visible deformity of the arm should be reviewed by your orthopaedic surgeon.
Key point: The anterior interosseous nerve runs close to the site of supracondylar fractures. Injury to this nerve — which controls fine pinch movements — is the most common nerve complication. Most recover spontaneously over three to four months. Let your surgeon know if your child cannot make an “OK” sign with their fingers after a supracondylar fracture.
Frequently Asked Questions About Elbow Fractures in Children
How do I know if my child’s elbow is fractured or just sprained?
A fracture typically causes swelling that develops quickly — within minutes to an hour — concentrated directly over the joint. Your child will resist moving the elbow and may hold it at a fixed angle. A sprain produces more diffuse tenderness. However, because the elbow contains growth plates that can mimic fracture lines on x-ray, and vice versa, the only reliable answer is an x-ray read by an experienced doctor.
Is surgery always needed for a child’s elbow fracture?
No. The majority of elbow fractures in children are managed non-surgically with a cast or backslab splint. Surgery is indicated when the fracture is significantly displaced, when blood vessels or nerves are compromised, or when the fracture cannot be held in position by a cast alone. Your orthopaedic surgeon will advise based on x-ray findings and clinical examination.
How long will my child need to wear a sling or cast?
Most elbow fractures require immobilisation for three to six weeks. The exact duration depends on the child’s age, the fracture type, and how quickly healing progresses on follow-up x-rays. Younger children heal faster. Your surgeon will confirm healing before removing the cast — do not remove it early even if your child reports the pain has gone.
Can my child return to sports after an elbow fracture?
Return to sport is guided by confirmed healing on x-ray and restoration of full range of motion and strength. This typically takes six to twelve weeks from the time of injury, depending on the fracture type. Contact sports and gymnastics should wait until your surgeon specifically clears your child — the risk of re-fracture at the same site is elevated until remodelling is complete.
What causes supracondylar fractures specifically?
Supracondylar fractures occur when a child falls onto an outstretched hand with the elbow in extension. The force travels up through the forearm and concentrates at the weakest point of the humerus just above the elbow joint. They are most common in children aged five to ten years, during the period when the bone in that area is relatively thin. Monkey bars and playground equipment are common settings for this injury.
Should my child see a paediatric orthopaedic surgeon or a general A&E doctor?
For initial assessment, an A&E doctor can take x-rays and apply a temporary splint. However, for definitive management — particularly for supracondylar and lateral condyle fractures, which require precise reduction — a paediatric orthopaedic surgeon should be involved. These fractures have a narrow margin for error. Seeing a specialist from the outset reduces the chance of needing corrective surgery later.
What are the long-term effects of an elbow fracture in childhood?
The majority of children who sustain elbow fractures recover full function with no lasting effects. Growth disturbance is rare but possible, particularly in lateral condyle fractures that involve the growth plate. Your orthopaedic surgeon will monitor the elbow during the growth years if there is any concern. In most cases, a well-treated childhood elbow fracture leaves no trace by adulthood.
Practical Tips for Parents During Elbow Fracture Recovery
Keep the cast or splint dry at all times. Use a waterproof sleeve for bathing. If your child complains of itching under the cast, do not insert objects to scratch — this can cause skin injury and infection. A cool hair dryer on the lowest setting directed into the cast opening can relieve itching safely.
Dress your child in loose-fitting, button-front tops that accommodate the cast. Maintain your follow-up appointments even if your child seems comfortable — healing confirmed by feeling is not the same as healing confirmed by x-ray. Write the date of each follow-up in your calendar and attend every one.
Finally, watch for the cast becoming loose as swelling subsides — a loose cast no longer immobilises the fracture adequately. If your child can slide their arm up and down inside the cast, return to the clinic for a replacement. A snug, correctly fitting cast is essential for proper healing throughout the full recovery period.
