Children: Elbow Fracture

Posted by galleca on May 11, 2009

Fractures about the elbow are very common in children, but the anatomy of the child’s elbow may make the diagnosis less obvious than in a mature skeleton. An understanding of the ossification and fusion of the secondary growth centers about the elbow is essential to avoid overlooking these injuries and to optimize treatment. If plain radiographs are equivocal, an arthrogram of the elbow may clarify the anatomy and diagnosis. Early neurologic and vascular complications are not uncommon and must be recognized before fracture reduction. Many late complications, such as malunion, osteonecrosis, and physeal bridging, are largely preventable by correct early diagnosis and treatment. Anatomic reduction of articular surfaces, restoration of physeal anatomy, and near-anatomic alignment of fracture fragments in the frontal plane are the corner-stones of successful treatment of pediatric elbow fractures.

What is an elbow fracture? An elbow fracture (FRAK-chur) is a break in one or more of the bones in your child’s elbow. It may also be called a broken elbow. The elbow is the joint where the upper arm bone (humerus) meets the two forearm bones (radius and ulna). The elbow joint helps greatly with arm movements.

What causes an elbow fracture? A fall on an outstretched hand, in an attempt to stop a fall, often causes an elbow fracture. This may also happen by falling directly on a bent elbow. Your child’s elbow may be broken while playing sports. A bad twist of the elbow and overuse of the elbow may also lead to fractures. Broken elbows may occur because of a direct blow or if the elbow is hit straight on.

What are the signs and symptoms of an elbow fracture? Your child may have pain, swelling, and bruising in the injured elbow. Your child’s arm may bleed if the skin is broken. The bones may poke through the skin, not look normal, or look bent or out of place. He may have a hard time moving his elbow, arm, or hand, or may refuse to use his elbow or arm. Your child may hold the elbow with his other hand to lessen the pain. Your child’s arm, elbow, or hands may feel weak, numb, or tingly.

How is an elbow fracture diagnosed? Imaging tests may be needed to see if your child has a broken bone. These may also be done to check for other injuries, such as a bone, muscle, or blood vessel problem. Your child may have one or more of the following:

• Bone scan: During this test, pictures are taken of your child’s bones. Your child is given a small, safe amount of radioactive dye in an IV. Caregivers can look at the pictures for broken bones, infection, or cancer in the bones.
• Computerized tomography scan: This test is also called a CT or CAT scan. This is a type of x-ray that uses a computer to take pictures of your child’s arm and elbow. Your child may be given a dye before the pictures are taken to help caregivers see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your child’s caregiver if your child is allergic to shellfish or has other allergies or medical conditions.
• Magnetic resonance imaging scan: This test is also called an MRI. The test uses magnetic waves to take pictures of your child’s arm and elbow.
• X-ray: This is a picture of the bones and tissues in your child’s elbow. X-rays of the elbow and arm may be done to check for broken bones or other problems. Several pictures of your child’s bones may be taken. X-rays of both your child’s injured and uninjured elbows may be needed.

How is an elbow fracture treated? Treatment will depend on how bad your child’s fracture is and whether other parts of his elbow are affected. Your child may need one or more of the following:

• Devices: Keeping the broken elbow from moving is very important. A splint or cast with a sling may be put on your child’s elbow and arm. This may be used to decrease pain and prevent further damage to the broken bones.
• Medicine: Medicines may be given to help with your child’s pain. Your child may need antibiotic medicine or a tetanus shot if he has a break in his skin.
• Supportive therapy: Ice packs may be put on your child’s elbow to decrease swelling, pain, and redness. Physical therapy may be needed once swelling and pain are gone. A physical therapist may assist your child with special exercises. This may help his elbow recover faster and become stronger.
• Surgery: Your child may need surgery with an elbow fracture, especially if his bones are out of place. It may also be needed if your child’s fracture does not heal with other treatments. Surgery helps return bones to their normal position by putting them together with pins, wires or screws. Surgery may also be done if your child has other injuries, such as nerve or blood vessel damage.