ELBOW INJURIES

Broken Elbow

Children are active and can fall onto their arms, thereby leading to a fracture. Whether your child is a toddler crawling around or an active little kid running around, there’s a high probability that he or she will fall at home or on the playground. If the child falls fast and under high pressure, the bone around the elbow may end up breaking. For example, we see a lot of broken elbows in children and these injuries account for about 10% of fractures in children.

At Medical City Children’s Orthopedic and Spine Specialists, our physical therapists, pain management specialists, and orthopedic specialists work together to provide customized treatment and recovery plans for children. Then we work with patients for as long as required to ensure that function gets restored and pain gets reduced or eliminated.

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

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

Radius

This is the forearm bone that 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

It is the other forearm bone that 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 following signs are noticed:

• 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 are usually caused by 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 commonest 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

The treatment administered for this type of elbow fracture is determined by 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 into the correct position through manipulation or surgical treatment.

Olecranon fracture

This type of elbow fracture is an injury to 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, it is important for children with a broken elbow to get treated correctly as soon as the child sustains the injury.

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

• The child’s age
• The location of the fracture
• If there is any type of damage to the nerves and blood vessels
• The severity of the displacement

Non-surgical treatment

It is important to stabilize elbow fractures as they can normally heal without applying a cast or splint.  So, the first step for a stable elbow fracture is for the doctor to reposition the bones before a splint or cast is applied. 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. However, it is easy to adjust them to accommodate swelling. When X-rays confirm an elbow fracture, splints work to stabilize the joint until the swelling goes down, and then cast the elbow. Also, the doctor may also schedule additional X-rays to ensure the bones are in the right place while they heal.

Casts are often used 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.

Surgical treatment

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

• Closed reduction and percutaneous pinning

This is a surgical procedure where the displaced fragments of the bone are repositioned during closed reduction and are 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 fixation

Fractures that are unable to be repositioned during a closed reduction and those that cause nerve or vascular damages require this type of surgical approach.

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; thereby, leading to the early closure of the growth plate. Although this is rare, the best way to know if the growth plate is permanently 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.

Schedule a Free Consultation for Your Child’s Elbow Care

Medical City Children’s Orthopedic and Spine Specialists 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.