What is Elbow Fractures Overview?
Elbow fractures are the most common type of bone breakage in children, usually resulting from a fall on an outstretched hand. Assessing and treating these fractures quickly is essential because they can pose a risk to the blood vessels and nerves in the area. There are several types of elbow fractures commonly seen in children:
Supracondylar Fractures: This fracture happens in the area just above the elbow, making up about 60% of all elbow fractures in children aged 5 to 10 years. The elbow either gets displaced towards the back (in about 95% of cases) typically caused by a fall on an outstretched hand, like falling from monkey bars. Or, the elbow gets displaced towards the front (less common, occurs in less than 5% of cases) usually a result of a direct force against a bent elbow. These fractures can be classified into three types based on the degree and direction of the displacement. One of the key risks associated with this fracture is the potential for damage to the brachial artery and median nerve, as they are located close to the fracture site.
Lateral Condyle Fractures: These are the second most common type of elbow fractures in children, making up 15% to 20% of all cases. This fracture happens to the outer bony prominence of the elbow in children aged 4 to 10 years. The break often extends across several parts of the bone, and the fracture can be classified according to the specific path of the fracture line or the degree of displacement.
Medial Epicondyle Fractures: These are the third most common type of elbow fractures and often occur in young teens engaged in sports like football, baseball or gymnastics. These fractures involve a part of the elbow located towards the back and inside, usually caused by the elbow being forcibly bent backwards or sideways. The main symptom is pain on the inside part of the elbow.
Radial Head and Neck Fractures: These comprise about 1% to 5% of all elbow fractures in children, most often happening in those aged 9 to 10 years. They involve the fracture of part of a bone near the wrist.
Olecranon Fractures: These are uncommon fractures in children and often occur with fractures of a bone near the wrist.
What Causes Elbow Fractures Overview?
Elbow injuries often happen when a person falls onto an outstretched hand or directly hits their elbow. Such injuries are most frequently seen in playgrounds, particularly during activities like playing on monkey bars.
Risk Factors and Frequency for Elbow Fractures Overview
A supracondylar fracture is the most common type of bone break in children under seven years old. These injuries make up around 15% of all bone fractures in children. The chance of having this injury is highest when children are around 6 years old, and it’s more likely to happen in boys.
Signs and Symptoms of Elbow Fractures Overview
Children often come to the emergency room complaining of severe, sharp pain in their elbow and forearm, and they can’t straighten their arm. Upon examination, it’s evident that the elbow is deformed, there’s swelling around the area, and even a slight touch results in pain. If they feel numbness in their forearm or hand, it might indicate a nerve injury. It’s also essential to check for a pulse to make sure the blood vessels are working correctly.
Testing for Elbow Fractures Overview
Imaging studies involve taking an X-ray from two directions: front to back and side to side. The X-ray is considered the best way to view the kind of break in the bone and to determine if the bones have moved out of their normal positions.
Treatment Options for Elbow Fractures Overview
Elbow fractures are generally managed in the same way, with minor differences.
Supracondylar Fracture:
If the fracture isn’t displaced, meaning the broken bones haven’t moved out of place, treatment involves immobilizing the elbow using a long arm posterior splint. The elbow is kept bent at a 90-degree angle, and the forearm is kept straight. Initially, a splint is used. Once any swelling goes down, it’s replaced by a cast. Regular X-ray checks ensure the bone is healing as expected, with the cast typically being removed after 3-4 weeks.
However, elbow fractures with more than 20 degrees of displacement need surgery. Here are the common techniques:
– Closed reduction and percutaneous pinning: This involves moving the displaced bone fragments back into place and securing them with metal pins. The area is then covered with a splint or a cast to keep it stable. The pins and cast are temporary and are removed once the healing process has started over the next few weeks.
– Open reduction and internal fixation: This is performed when closed reduction fails, in cases of vascular insufficiency, open fracture, or if there’s risk of the brachial artery becoming entrapped. It involves hospitalization to monitor nerve and blood vessel function.
Lateral Condyle Fracture:
This is treated similarly to supracondylar fractures. However, it requires a cast for a longer period (up to six weeks), and close monitoring as the fracture might move or shift.
Medial Epicondyle Fracture:
This is treated like supracondylar fractures, but with a slight change – instead of pins, small screws hold the bone fragments together. Therefore, recovery is shorter and less time in a splint or cast is required – usually a week or two.
Radial Head and Neck Fracture:
The treatment for this depends on the amount of displacement. If the displacement is less than 30 degrees, a collar is used to immobilize it without needing closed reduction. But if the displacement is more than 30 degrees, closed reduction is necessary. A procedure called percutaneous pinning is used if closed reduction is unsuccessful. A K-wire is inserted to keep the reduction in place.
What else can Elbow Fractures Overview be?
- Nursemaid elbow (a common condition in young children where the elbow easily dislocates)
- Elbow dislocation (which requires immediate medical attention)
- Forearm injuries (which might include fractures, a common type of emergency)
- Injuries of the distal humerus (the lower part of the upper arm bone)
- Bursitis (a painful condition involving inflammation of the small fluid-filled pads that act as cushions at the joints)
- Avulsions (a condition where a tendon or ligament pulls off a piece of bone)
- Tendinopathic conditions (problems related to the tendons, which connect muscles to bones)
- Humerus fractures (breaks in the upper arm bone)
- Ligamentous insufficiencies (when the ligaments in the elbow are weak or damaged)
