Paediatric Elbow Trauma Repair Information
The elbow is a hinge joint composed of three bones:
- The ulna, one of the forearm bones between the elbow and wrist. When the palm is facing up the ulna is on the pinky side (medial side) of the forearm
- The radius, the other forearm bone between the elbow and wrist. When the palm is facing up, the radius is on the thumb side (lateral side) of the forearm
- The humerus, the upper arm bone between the shoulder and the elbow
The humerus and the paired radius and ulna meet to form the elbow joint. The olecranon is the bony prominence of the elbow. It is positioned directly under the skin of the elbow without much protection from muscles or other soft tissues.
For this reason, injuries and fractures of the elbow are common and are often accompanied by injury to the shoulder or wrist joints. The joint can easily fracture if you experience a direct blow to the elbow or fall on a bent elbow.
Types of Elbow Fractures
There are several types of elbow fractures including:
- Supracondylar: This type of fracture occurs above the elbow in the humerus. This is the most common type of elbow fracture and also one of the most serious as it can result in nerve damage and impaired circulation. These types of fractures generally occur in children younger than eights years old.
- Condylar: This type of fracture occurs at the elbow through one of the condyles (the bony knobs at the end of the humerus). Most tend to occur through the lateral (outer condyle). These types of fractures require careful treatment as a fracture here can disrupt the growth plate and the joint surface.
- Epicondylar: These types of fractures occur at the inside of the elbow tip at the epicondyle (the bony projection of each condyle). These tend to occur on the medial (inside) epicondyle in children 9 to 14 years of age.
- Growth Plate: Both the humerus, the ulna and the radius have areas of cartilage called growth plates located at the end of the bone. The growth plates help bring a bone to maturity and thus a fracture which disrupts the growth plate can interfere with bone formation and lead to deformity if not treated correctly.
- Forearm: A severe elbow dislocation can break off the head of the radius and excessive force can also result in a compression fracture to the radius.
- Monteggia Fracture: This type of fracture is associated with the dislocation of the top of the radius of the elbow. If the dislocation is not identified early and the fracture treated it can lead to permanent impairment of elbow joint function.
- Compound Fracture: When a bone breaks through the skin it is referred to as a compound fracture. A compound fracture carries a greater risk of infection and often involves further damage to the muscles, tendons and ligaments resulting in a longer healing time.
The most common fractures occur upon falling onto an outstretched arm. Radial head fractures are the most common injury in adults, whereas radial neck fractures occur more commonly in children.
Elbow Fracture Signs and Symptoms
- Swelling of the elbow and surrounding tissue
- Limited range of motion, particularly forearm rotation and elbow extension with pain increasing while doing these movements
- Often the arm will be held in pronation (palm facing down) unable to be moved
- Inability to straighten elbow
- The injured forearm may appear shortened
- Grating, cracking or popping feeling in arm when the condyles are pressed together
- Numbness in one or more fingers
An elbow intercondylar fracture is confirmed with x-rays to assess the severity of the injury and any associated injuries. In children they can be difficult to diagnose, as radial head ossification does not occur until age four. Further ultrasound or MRI scans may be needed to confirm the diagnosis.
Surgery is recommended as the best course of action following an elbow fracture, especially if there is evidence of nerve or vascular involvement.
Complex fractures require open reduction and internal fixation.
During the procedure an incision is made over the back of the elbow and the bone fragments are first reduced (repositioned) into their normal alignment. The bones are then positioned and held together by a plate attached to the outer bone using pins and screws. In some cases a screw or rod inserted into the bone may be used to keep the bone fragments together while they heal.
If some of the bone is missing or crushed beyond repair (fragments of bone broken off in an accident for example) the fracture may require a bone filler. This can be supplied by the patient (typically taken from the pelvis) or fragment of bone from a bone bank or using an artificial calcium-containing material.
After the incision is closed, a splint may be placed on the arm depending on the severity of the injury.
Most patients will return to full range of motion in the elbow following surgery and can be expected to return to normal activities within four to six months. However, full healing and return to sports may take longer.