ELBOW Fracture

Anatomy of the Elbow

The elbow joint comprises three bones that allow the elbow to bend and straighten. These bones also allow the forearm to rotate. They include:

Humerus

This bone is found in the upper arm and runs from the shoulder to the elbow.

Radius

This forearm bone runs from the elbow to the wrist. It is found on the thumb side of the forearm. The bone rotates when the wrist rotates.

Ulna

This forearm bone runs from the elbow to the wrist. It is found on the pinky side of the forearm. Also, the ulna acts as the hinge in the elbow and allows the elbow to bend and straighten.

What Are Broken Elbows?

A broken (or fractured) elbow refers to a break at or close to the elbow joint. The break occurs in one or more of the three bones that make up the elbow. A broken elbow usually occurs in children as a result of an impact injury. As such, we treat this injury by splinting or casting the affected area for about 1 month.

Symptoms of a Broken Elbow

The child may have a broken or sprained elbow if the parent notices the following:

• Swelling of the elbow or in areas above or below the elbow
• Deformed elbows (or deformity in the areas above or below the elbow)
• Discoloration, redness, or bruising of the elbow
• ‘Tight sensation’ in the forearm or areas of the elbow
• A cut on the elbow after an injury
• Numbness or a cool sensation in the forearm, hand, or fingers
• Inability or difficulty moving the elbow via its complete range of motion

Causes of Broken Elbows in Children

Broken elbows in children usually occur because of the following:

• The child falling on his or her elbow
• A fall on an outstretched arm, and
• A direct blow to the elbow

Children are always involved in activities that make them prone to injuring their elbows. Also, we see most of the elbow injuries occurring on the playground when the child falls after losing their grip on the monkey bars. If a toddler falls from a lower height, he or she can also sustain an elbow fracture.

Fractured elbows also occur in sports, like football or gymnastics, or recreational activities like bicycling or skateboarding. Consequently, children can avoid the risk of breaking an elbow by wearing protective elbow guards and pads.

Types of Elbow Fracture

The common types of fractured elbows include:

Supracondylar humerus fracture

This is the most common type of elbow fracture. It occurs through the growth plate of the humerus (found above the elbow joint). This type of elbow fracture is usually caused by a fall onto an outstretched arm. It is usually found in children that are 5 to 7 years old.

Condylar fracture

This fracture also occurs just above the elbow joint. It occurs when a child breaks one side of the elbow joint.

Radial neck fracture

Doctors treat this type of elbow fracture based on the angle at which the fracture occurred. The treatment comprises casting, manipulation, or placing pins across the fracture.

Radial head subluxation

Although this does not involve a broken bone, young children often have this common injury. When this type of injury occurs, the elbow joint will slide out of its position. Doctors will return the elbow joint to the correct position through manipulation or surgical treatment.

Olecranon fracture

This type of elbow fracture injures the prominent bone located at the back of the elbow. Doctors know that differentiating injuries to this bone from the normal appearance of growth plates is problematic.  An X-ray of both elbows will assist in the diagnosis.

Diagnosis

To diagnose a broken elbow, the doctor will check the skin around the elbow, forearm, and wrist and will also touch these areas to discover the area that hurts. In addition, the doctor may also try to move the joints.  And then test the nerves and circulation to the hand. In most cases, X-rays are needed to diagnose a broken elbow. Since forearm fractures are associated with elbow fractures, the doctor may request X-rays of the forearm as well.

In young children, the bones in the elbow are made up of cartilage and are also soft; they do not reflect in the X-ray. In this case, the doctor may order X-rays of the other elbow to compare them. The doctor may also ask for an MRI ultrasound or an arthrogram, whereby dye gets injected into the joint. This will help the doctor to see the surfaces of the bones and the elbow joint.

Treatment

If a broken elbow heals in the wrong position, the elbow may become permanently distorted and may not have a full range of motion. Therefore, as soon as a parent finds that their child sustained a broken elbow, the child should be taken to a pediatric orthopedist for treatment as soon as possible.

The specific treatment administered for a broken elbow depends on the following factors:

• The child’s age
• The location of the fracture
• Damage to the nerves and blood vessels
• The severity of the displacement

How Clinical Trials Advance Elbow Fracture Treatments

Clinical trials play a crucial role in enhancing the management and treatment of elbow fractures. These research studies thoroughly examine the effectiveness and safety of new medical methods, devices, drugs, and other treatment approaches specifically designed to address such injuries.

Key Contributions of Clinical Trials:

• Innovative Approaches: Clinical trials test groundbreaking techniques and technologies, offering insights into improved surgical methods or therapies that can expedite recovery and minimize complications.
• Drug Effectiveness: Trials help assess new medications or drug combinations that could potentially reduce pain, inflammation, or accelerate the healing process in elbow fractures.
• Patient-Centric Developments: Participants in clinical trials provide valuable data on the comfort and success of new treatments, helping tailor interventions to meet diverse patient needs.
• Long-Term Outcomes: Research tracks the long-term effects of different treatments, contributing to evidence-based protocols that enhance patient care standards.

By participating in clinical trials, researchers and patients alike contribute to the discovery of advanced treatments, ultimately improving recovery rates and quality of life for individuals with elbow fractures.

Non-surgical treatment

Parents need to stabilize their child’s elbow fracture as soon as possible because they can normally heal without applying a cast or splint. So, the next step for the parent is to have a doctor reposition the bones before a splint or cast is applied.

Casting or Splinting: If the fracture is stable without any displacement, the doctor may apply a splint or cast to an active child to ensure that the bones remain in proper alignment while healing. Unlike casts, splints provide less support but are easier to adjust in response to swelling. Initially, splints are used to stabilize the joint until swelling decreases, after which a cast is typically applied. This approach helps maintain proper bone alignment, crucial for effective healing.

Medication: Pain management is another critical component. Over-the-counter medications, such as acetaminophen, are commonly recommended to alleviate minor discomfort. For more severe pain, stronger prescription medications might be necessary, ensuring that the child remains comfortable during the recovery process.

Physical Therapy: Not moving the elbow for an extended period can result in stiffness, making daily activities challenging. Doctors may recommend beginning regular stretching or exercises soon after the injury. Physical therapists specialize in creating tailored exercise plans to strengthen the injured muscles without risking further harm, helping to restore mobility and function over time.

When X-rays confirm an elbow fracture, splints work to stabilize the joint until the swelling goes down and then cast the elbow.  Doctors often use casts to treat elbow fractures. More commonly, we will splint the joint for a week while the swelling subsides, and then put a cast on the child’s arm. Regular monitoring and adjustments ensure that the healing process is on track, minimizing complications and promoting a full recovery.

Surgical treatment

If the bone fragments appear displaced, surgery becomes necessary to make sure the fracture heals completely. The surgical treatments used for broken elbows include:

• Closed reduction and percutaneous pinningThis surgical procedure joins displaced fragments of the bone during closed reduction and becomes held in place with metal pins. During the procedure, the surgeon will insert the pins through the skin, into the bone, and across the fracture. Accordingly, the affected area gets protected for the first week with a splint. When healing has begun, a few weeks after surgery, the surgeon will remove the pins and the cast.
• Open reduction and internal fixationFractures that do not respond to alignment during a closed reduction and those that cause nerve or vascular damage require a surgical approach. In this procedure, the surgeon makes one or more incisions to access and carefully realign bones. Depending on the injury, they may also remove bone fragments or use metal rods or plates to fully repair or stabilize the affected area.

Orthopaedic specialists often employ the latest implant technologies to improve healing outcomes, ensuring stability and reducing recovery time. They are skilled in using minimally invasive techniques where possible, which can lower the risk of complications and help patients experience less pain post-surgery.

By combining years of experience with cutting-edge technology, orthopaedic specialists offer comprehensive care for complex elbow fractures, tailored to the unique needs of each patient.

Recovery

Irrespective of the treatment method used, the doctor will place the arm in a cast or splint for about 3 to 6 weeks, depending on the type of fracture. When the fracture has healed, the doctor may recommend some types of exercise to improve the joint’s range of motion. After treatment, the range of motion of the elbow usually returns to normal or may have a mild limitation.

Long-Term Complications of a Broken Elbow

Since elbow fractures occur around the growth plate, the growth plate can get injured.  This can lead to the early closure of the growth plate. Although rare, the best way to know if the growth plate is injured is for the orthopedic surgeon to monitor the growth of the child’s limb.

Other long-term complications of a broken elbow include:

• Damage to nerves and blood vessels around the elbow
• Restriction of the movement of the elbow joint, and
• Infection of the pins placed into the elbow

Here at Medical City Children’s Orthopedic and Spine Specialists, our doctors will follow your child to monitor the condition of the injury until it heals completely. We may also ask for a follow-up to make sure that growth and movement around the elbow return to normal.

Patients with elbow fractures have unique opportunities to engage in groundbreaking research studies that explore new treatment methods. These studies might offer access to innovative therapies that aren’t widely available yet, providing a chance to contribute to advancements in medical science. The programs conducting these studies are often part of top-tier orthopedic departments. Participating in such research not only aids personal recovery but also advances the field of orthopedic care.

Schedule a Free Consultation for Your Child’s Elbow Care

Medical City Children’s Orthopedic and Spine Specialists with offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX is a board-certified, fellowship-trained orthopedic group that uses both surgical and non-surgical techniques to treat spine diseases, sports injuries, musculoskeletal trauma, and degenerative diseases. As such, our specialists provide cutting-edge and comprehensive care in diagnosing and treating broken elbows. Also, we use the latest state-of-the-art treatment methods to return children, adolescents, and adults to their active lifestyles.

Finally, speak to one of our compassionate and expert orthopedic surgeons today to learn more about your child’s broken elbow and the specific treatment procedure to reduce and eliminate pain.

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Footnote:

American Academy of Orthopaedic Surgeons: Broken Elbow