Elbow fractures in children
Elbow fractures are usually the result of reasonably high energy trauma. In children, elbow fractures occur commonly. The most frequent mechanism for a child to injure their elbow involves a fall on their arm with the elbow in an extended position.
Children will often have what are called 'supracondylar' fractures. These fractures occur just above the joint surface of the elbow. Whilst the fracture doesn’t extend into the articular surface, they still can be very significant injuries.
Treatment
The treatment options will depend upon the degree of displacement at the fracture site. Simple fractures that are well aligned with no displacement, can be managed in a back slab and sling.
In cases where there has been displacement of the fracture site, they may require reduction (where the fracture is restored to the correct alignment) under an anaesthetic and stabilisation with wires.
In severely displaced supracondylar fractures, local structures can be damaged. This includes nerves that travel across the front of the elbow joint region as well as arteries. On occasions, arterial repair may be required to restore blood flow to the arm.
Supracondylar fractures with displacement need to be dealt with urgently.
Post Treatment Care
Once the fracture has been reduced and stabilised, it is usually held in a cast for at least a four-week period. In most children, these fractures heal rapidly. After that, activities are still significantly restricted to allow the fracture to mature.
One of the biggest difficulties following an elbow fracture is stiffness. Even with a non-displaced supracondylar fracture, patients may struggle to regain full extension for quite some time. The main arc of movement usually returns quite quickly but the last few degrees of extension and flexion can take many months to return.
Lateral Condyle Fractures
Lateral condyle fractures of the humerus are sometimes seen in children. These fractures occur at the end of the humerus and extend into the elbow joint itself. These fractures require accurate reduction and in most cases open reduction and internal fixation is needed. With these fractures, regular follow up is required after the fracture has healed, to check that the elbow is continuing to grow proportionally.
Elbow fractures in adults
Adult elbow fractures are less common, however they can be very debilitating.
Treatment
Each fracture is unique and the treatment options will depend on the degree of displacement. Simple non-displaced fractures can sometimes be treated with a period of immobilisation.
If the joint surface has been disrupted, accurate reduction will be required. In all cases, stiffness is a significant risk. Even with accurate restoration of the joint surface anatomy, post-operative scarring and post injury swelling can lead to a limitation in range of movement.
In most instances, the fractures can be reduced and held with plates. In some cases where there is severe comminution (fracturing into many pieces of bone) of the articular surface, consideration can be given to joint replacement. This may involve either a half joint replacement which resurfaces one side of the joint or a total joint replacement.
Radial head fractures are relatively common and in some cases a radial head prosthesis may be required.
Elbow fractures are investigated with plain x-rays. Depending on the severity of the injury, a CT scan may also be required to define the extent of the bone damage.