Broken Elbows In Children

Broken Elbows can be serious injuries. Some need surgery, but most can be treated in a cast.

broken-elbow-ct-scanOverview

Broken elbows in children are common because normal, playful kids are involved in activities that put them at risk for injuries to the elbow and arm.

It’s a normal part of growing up, but any injury to your child is a gut-wrenching, stressful event.

This overview article will help summarize elbow fractures and what can be done to treat them.

Can broken elbows be dangerous?

Elbows in kids are vulnerable to fractures and breaks. Most elbow fractures heal on their own and do not need surgery.

That being said, any elbow injury in a child is potentially serious and needs careful evaluation by an orthopedic surgeon, preferably one who specializes in arm fractures or children’s orthopedics in general.

Broken elbows can cause:

  • cosmetic deformity – permanently angled arms
  • permanent stiffness (elbow doesn’t bend or straighten normally)
  • chronic pain in the elbow
  • bone deformity requiring complex surgery later
  • joint deformity that turns into arthritis later
  • pressure on and damage to nerves and blood vessels

What causes elbow fractures in kids?

Most fractures are caused by a fall from high up, like from monkey bars or off a bunk bed. However, some breaks happen just from falling from a standing position or off a bike.

More rarely an arm gets trapped in a tight spot while the child falls, and the arm is twisted violently, breaking the elbow.

Elbow fractures can also happen in car wrecks, karate injuries, sports injuries, gymnastics, and general goofing off with parents, siblings, and friends.

Common types of elbow fractures

The elbow is made up of three bones: humerus, radius, and ulna. All three could be fractured at the same time, but there’s usually one main break in one bone.

Humerus fractures

The most serious humerus fracture is a supracondylar fracture (just means above the elbow joint). This fracture can cause nerve and blood vessel damage and even be violent enough to push bones through the skin.

Radius fractures

The radius bone up by the elbow is involved in turning and twisting the hand and forearm, like when you twist a screwdriver to turn a screw.

Fractures of the radius usually are not very crooked and most heal just fine with a simple cast. Surgery is not often needed for these fractures.

Ulna fractures

The ulna bone is mainly involved in bending and straightening the elbow joint (like a hinge).

This bone usually breaks when a child lands directly on the point, or back of the elbow (on the hard bone most people think of as the elbow). A break here is called a fracture of the olecranon process (the tip of the ulna bone by the elbow).

Signs of an elbow fracture

Parents sometimes tell me they tried to figure out if their child’s elbow was broken or just bruised. Here are some telltale signs of a broken elbow:

  • lots of swelling
  • difficulty moving the elbow
  • pain when moving the elbow
  • crunching when moving the elbow
  • areas of purple bruising up the arm or around the elbow
  • extreme tenderness/pain when touching the elbow
  • refusal to use the arm or put weight on it

When to take your child to the doctor

Always take your child in to see the doctor if you have even a shred of suspicion he or she has a fracture.

Only a careful examination and x-ray can confirm a suspected fracture. Sometimes if the specialist has enough experience, he may be confident enough to say there’s no break and recommend a week of rest before resuming activities.

How elbow fractures are diagnosed

Fractures around the elbow can be difficult to diagnose. A specialist can determine if a break is present by examining your child and seeing a couple of well-done x-rays.

Sometimes even orthopedic surgeons cannot see a fracture line on the x-ray, and the safest treatment is a few weeks in a cast. The last thing you want is a break that starts out perfectly lined up, but then moves and shifts and gets worse because it wasn’t properly immobilized in a cast.

Treating your child’s elbow fracture

Casts

Treatment for elbow fractures usually involves a cast going up the entire arm, from the hand (leaving fingers free) to the arm (above the elbow). This is called a long arm cast.

Depending on the child’s age, casts need to be in place for at least 4 to 6 weeks so the bone can heal solid.

Sometimes several re-checks of x-rays are necessary to make sure the bones are not shifting or moving in the cast.

Surgery

If the doctor recommends surgery – don’t panic – just ask careful questions!

Sometimes surgery may simply mean putting your child to sleep and straightening the elbow, then putting on a cast or splint.

The next most invasive type of surgery rarely involves incisions. Even badly displaced (bones out of alignment) breaks can be fixed with small metal pins placed through the skin. Usually these pins are covered up by a large splint or cast.

On rare occasion a fracture is bad enough to require an incision to fix the bones. Just ask your surgeon how likely this will be at the time of your appointment.

Results of treatment

As I mentioned before, most elbow fractures heal just fine on their own, with cast treatment for about six weeks.

Even fractures that need surgery heal in the same amount of time after the operation.

After the cast comes off or pins come out, therapy is rarely needed, and most chldren adjust to their new arm within a week or so.

In fact, most kids in casts are running around like their normal selves making their doctors nervous while their bones are healing. After six weeks, most children are hesitant to get the cast off because they’ve gotten so used to it.

Elbow fracture video

This video gives a good overview of an elbow fracture example, showing x-rays (with pins on the x-ray) but nothing gory or messy.

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