Elbow Fractures

Elbow Fractures in Children

The elbow is a joint that consists of three bones – the humerus (upper arm bone), and radius and ulna (forearm bones). An elbow fracture most commonly occurs when your child falls on an outstretched arm. It can lead to severe pain in the elbow and numbness in the hand. Fractures are more common in children due to their physical activities as well as their bone properties. Children’s bones have an area of developing cartilage tissue called a growth plate which is present at the end of long bones that will eventually develop into solid bone as the child grows.

Your child’s doctor first evaluates your child’s arm for signs of damage to blood vessels and nerves. An X-ray examination is then ordered to confirm and determine the severity of the fracture. Treatment of elbow fractures depends on the degree of displacement and type of fracture:

  • Nonsurgical treatment: If there is little or no displacement from the normal position, nonsurgical treatment is recommended. Your child’s doctor may immobilise the arm using a cast for 3 to 5 weeks. Regular X-rays are ordered to check if the bones are properly aligned.
  • Surgical treatment: Surgery may be recommended if the fracture has caused the bones to move out of alignment. Your child’s doctor brings the bones into correct alignment and may use metal pins, screws and wires to hold the bones in place. Your child must wear a cast for a few weeks. Exercises to improve the range of motion will be instructed after a month of healing.

Radial Head Fractures of the Elbow

The elbow is a junction between the forearm and upper arm. The elbow joint is made up of 3 bones namely the humerus bone in the upper arm, which joins with the radius and ulna bones in the forearm. The elbow joint is essential for the movement of your arms and to perform daily activities. The head of the radius bone is cup-shaped and corresponds to the spherical surface of the humerus. The injury in the head of the radius causes impairment in the function of the elbow. Radial head fractures are very common and occur in almost 20% of acute elbow injuries. Elbow dislocations are generally associated with radial head fractures. Radial head fractures are more common in women than in men and occur more frequently in the age group of 30 and 40 years.

The most common cause of a radius head fracture is breaking a fall with an outstretched arm. Radial head fractures can also occur due to a direct impact on the elbow, a twisting injury, sprain, dislocation or strain.

The symptoms of a radial head fracture include severe pain, swelling in the elbow, difficulty in moving the arm and visible deformity, indicating dislocation, bruising and stiffness.

Your doctor might recommend an X-ray to confirm the fracture and assess the displacement of the bone. Sometimes, your doctor might suggest a CT scan to obtain further details of the fracture, especially the joint surfaces.

The treatment of a fracture depends on the type of fracture.

  • Type 1 fractures are usually very small. The bone appears cracked but remains fitted together. The doctor might use a splint (casting) to fix the bone and you might have to wear a sling for a few days. If the crack becomes intense or the fracture gets deep, then your doctor might suggest surgical treatment.
  • Type 2 fractures are characterised by the displacement of bones and breaking of bones in large pieces. This can be treated by surgery. During surgery, your doctor will correct the soft-tissue injuries and insert screws and plates to hold the displaced bone firmly together. Small pieces of bone may be removed if it prevents normal movement of the elbow.

Type 3 fractures are characterised by multiple broken pieces of bone. Surgery is considered the compulsory treatment to either fix or remove the broken pieces of bone, sometimes including the radial head. An artificial radius head may be placed to improve the function of the elbow.

Distal Humerus Fractures of the Elbow

The elbow is a region between the upper arm and the fore arm. The elbow joint is made up of 3 bones. The distal (lower) end of the humerus bone in the upper arm joins with the radius and ulna bones in the fore arm to form the elbow joint. The elbow joint is very important for the movement of your arms and for coordination of daily activities. Injury in the distal humerus can cause impairment in the function of the elbow joint. A distal humerus fracture is a rare condition that occurs when there is break in the lower end of the humerus. The treatment of distal humerus fracture aims at restoration of the normal anatomy.

Causes

A distal humerus fracture may result due to a fall. This occurs more often when you land directly on your elbow during the fall or when you get struck by a hard object. It can also happen when you fall on your outstretched arm with the elbow locked straight.

Symptoms

Distal humerus fractures are usually very painful. The other common symptoms are swelling, bruising, stiffness, tenderness and inability to move the arm.

Diagnosis

Distal humerus fractures are generally considered an emergency condition. Your doctor may examine the skin to check for any cuts and feel it to determine the presence of broken bones or injuries. Your doctor may recommend an X-ray to determine the depth (intact or broken bones) of the fracture.

Treatment

Distal humerus fractures can be treated by both non-surgical and surgical methods based on the intensity of the fracture.

Non-surgical Treatment

If the fracture has not caused displacement of the bone, then your doctor may apply a splint (a casting), and you may be required to wear a sling until complete healing and recovery occurs.

Surgical Treatment

Your doctor may recommend surgery if the fracture has led to the displacement of bone and the pieces of the bone have exited the skin. During surgery, the displaced bone or pieces of bone are joined together with the help of metal screws and plates. You may also be given antibiotics to avoid the risk of infection.

Prevention

Care should be taken while you walk or run and especially while climbing up/down the stairs. This can prevent you from falling and eventually from accidental fractures.