Children can be daredevils. Even when they’re appropriately equipped and supervised, it’s natural for kids to underestimate the dangers associated with playground activities, sports, and roughhousing.
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 and which 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 may invite a different kind of injury than 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, for instance when slipping off monkey bars, and land with outstretched arms, 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, but 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 such a wide variety of ways that 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 (say, bracing for a fall on a playing field), the ulna forms its prominent bony point, 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 your paediatrician. That said, some children may be quicker than others to bounce back after a fall, and the symptoms of an elbow fracture may appear over the course of hours or days. Here’s what to look for.
Lingering elbow pain. Be sure to follow up with your child and ask about any lingering pain over the few days following an injury, especially if your child tends to be stoic about such things.
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 related to an elbow fracture may appear a few inches away from the centre of the joint itself.
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 so it can be 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.
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
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.