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St. Mary's Center for Orthopaedics

Elbow Fractures in Children

Three arm bones form the elbow joint:

  • Radius: the bone on the thumb side of the forearm.
  • Ulna: the bone on the little-finger side of the forearm. The ulna forms the tip of the elbow.
  • Humerus: the upper arm bone that connects to the shoulder.

A child can experience a fracture in several places about the elbow including:

Supracondylar – above the elbow. The upper arm bone (humerus) breaks slightly above the elbow. These fractures usually occur in children younger than eight years of age. This is the most common elbow fracture, and one of the more serious because it can result in nerve damage and impaired circulation.

Condylar – at the elbow knob. This type of fracture occurs through one of the bony knobs (condyles) at the end of the upper arm bone. 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.

Epicondylar – at the inside of the elbow tip. 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.

Physis – growth plate. 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 if not treated promptly.

Forearm. An elbow dislocation can break off the head of the radius bone, and excessive force can cause a compression fracture to that bone as well. Fractures of the tip (olecranon) of the other forearm bone (ulna) are rare.

Fracture dislocation. The ulna and the radius make up the bones of the forearm and meet the bones of the hand at the wrist. A fracture of the ulna associated with a dislocation of the top of the radius at the elbow is called a Monteggia fracture. If the dislocation is not seen, and only the fracture is treated, this can lead to permanent impairment of elbow joint function.

Types of Fractures

Bones can break in many ways. Common types of fractures in children are:

  • Greenstick: The bone bends, but doesn’t break all the way through.
  • Nondisplaced: The bone breaks completely, but the ends stay lined up.
  • Displaced: The pieces of broken bone do not line up.
  • Growth plate: A break near or through the growth plate, the soft part of a bone where the bone grows as the child grows. A growth plate injury can slow growth in that bone. Growth plate injuries may be difficult to treat.

Fractures can be:

  • open (the broken bone comes through the skin). These used to be called “compound” fractures.
  • closed (the broken bone does not come through the skin).

What Causes Elbow Fractures?

Elbow fractures usually result from:

  • Falling on an outstretched hand.
  • Falling on the elbow.
  • Forcing the elbow joint to move in an unnatural way.
  • Receiving a hard blow to the elbow.

Many elbow injuries occur at playgrounds when children are playing on monkey bars. They lose their grip, slip off, and fall onto an outstretched arm. For younger toddlers, falls from lower heights, such as the bed or couch, are often responsible for elbow fractures as the child puts his/her arm out to break the fall.  Children who are active athletes need to wear the proper protective equipment. Elbow guards and pads can help reduce the risk of a fracture about the elbow.

What Are the Signs and Symptoms of an Elbow Fracture?

  • Swelling of the elbow
  • Pain
  • Bruising or discoloration of the skin around the elbow
  • Deformity of the elbow
  • Stiffness, making the elbow difficult to move

How Are Elbow Fractures Diagnosed?

The doctor will ask about your child’s health history and examine your child. An imaging test, such as an x-ray, will be done. Imaging tests show areas inside the body such as the bones. They give the doctor more information about your child’s injury.

Around the elbow, there will be

  • Tenderness
  • Swelling (may be severe or mild)
  • Bruising
  • Limited movement
  • Potentially, the hand may be dusky if the circulation has been affected

During the physical examination, your doctor will check to see whether there is any damage to the nerves or blood vessels.

How Are Elbow Fractures Treated?

Non-surgical Treatment
If the fracture forced the bones out of alignment, the surgeon will have to manipulate them back into place. Sometimes, this can be done without surgery. If there is little or no displacement, the surgeon may immobilize 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.

Surgical Treatment
For fractures of the joint, of the growth plate, or severe fractures, surgery may be necessary. During surgery, fixation devices (pins that go through the skin into the bone) may be put into broken bone to hold it in place while it heals. These devices may need to be taken out by the doctor about 3-6 weeks after surgery.  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.

Your child’s treatment plan is determined by the type, location, and severity of the fracture. As instructed, your child should:

  • Ice the elbow 3-4 times a day for 15-20 minutes at a time.  Do this to help relieve pain and swelling.
  • Wear a splint (device that keeps the elbow still so it can heal) as instructed.
  • Wear a cast for 3-6 weeks.
  • Elevate the arm to reduce swelling. Keep the elbow above heart level as often as possible.
  • Do physical therapy to restore range of motion once the cast is removed.
  • Increasing pain
  • Tingling, numbness, or pain around his or her cast or splint
  • Increasing swelling around the injured area
  • Fingers that change color or feel cold
  • Severe itching under a cast (mild itching is normal)
  • A cast that feels too tight or too loose

Notify the surgeon if your child has any of the following:

  • Increasing pain
  • Tingling, numbness, or pain around his or her cast or splint
  • Increasing swelling around the injured area
  • Fingers that change color or feel cold
  • Severe itching under a cast (mild itching is normal)
  • A cast that feels too tight or too loose

What Are the Long-Term Concerns?

Once the child’s cast is removed, his or her elbow may have:

  • Temporary stiffness and some loss of motion. This is normal. The elbow should still work well.
  • Pain for 2-3 weeks, while the elbow continues to heal.
  • A different appearance than before the injury.

In severe cases, the nerves and arteries of the elbow can be injured. This can cause complications and make healing more difficult; the surgeon would provide more information.