When kids play hard, they fall hard. Enough force applied to an outstretched arm can cause a fracture. According to the American Academy of Orthopaedic Surgeons, 10% of all fractures in children are elbow fractures. A child can fracture their elbow in several areas outline below.
- Above the elbow — (primarily occurs in children under the age of 8) When the upper arm bone breaks, it can cause nerve damage.
- At the elbow knob — These injuries can affect the growth plate of the humerus and joint surface.
- Below the elbow — Dislocation of the elbow can break off the tip of the radius (smallest forearm bone) or cause a compression fracture.
Treating the fracture depends on its severity and location. The orthopedist may carefully move the bones back into alignment and apply a cast for 3 to 5 weeks. Some cases require surgery or immobilizing the fracture with pins.
The American Academy of Orthopaedic Surgeons reports that 40 - 50% of kids' fractures occur in the forearm. High energy, contact sports place kids at greater risk for forearm fractures. Falling with an outstretched arm can cause a fracture to one or both of the bones (ulna and radius) of the lower arm. If the area has any deformity, acute pain, tenderness, swelling or inability to rotate, you should see an orthopedic physician.
Treatment of forearm fractures depends upon the following factors:
- If the skin is broken
- If the break is unstable
- If bone segments are out of alignment from the bone
- If the bones can be realigned by manipulation
- If the bones have begun to heal incorrectly
A serious fracture in which both forearm bones are broken and the head of the radius is dislocated usually requires complete immobilization for six to ten weeks. It is important to act quickly if you suspect that your child may have a broken bone.
Hand and Wrist Fractures
The wrist is made up of 8 small bones and two forearm bones (the radius and ulna). The bones of the hand and wrist are held together by ligaments that come together forming multiple large and small joints. This shape and makeup of the bones, joints, cartilage and ligaments allow the wrist to bend and straighten, move side-to-side, and maintain its normal range of motion. Three quarters of wrist injuries are fractures of the distal radius and ulna. The eight carpal bones are actually injured less frequently.
When enough force is applied to the wrist, such as when falling down with an outstretched hand, wrist fractures may occur in any of these bones. Severe wrist injuries can happen from a more forceful injury, such as a hard football tackle. The most commonly broken bone of the wrist is the radius.
When one of the wrist bones is fractured, there is often swelling that is accompanied by pain and decreased use of function. Wrist fractures will often appear deformed and crooked. Some wrist fractures may be simple and stable, while other more severe wrist fractures will be unstable and the bone fragments tend to displace or shift. An unstable fracture may be the result from a hard impact in which the bone is shattered into many pieces.
An open (compound) fracture occurs when a bone fragment breaks through the skin. This is a very severe injury and there is a higher risk of infection with compound (open) fractures. This type of injury requires immediate hospitalization and surgery to stabilize the wrist. It is very important to let the bones heal in the proper position.
As with most wrist injuries where a fracture might have occurred, the doctor will need to review x-rays in order to determine if there is a fracture and assess the position of the bones, in order to help determine the correct treatment plan.
Often with a severe fracture of a bone it will contribute to tendons, muscles, and nerve damage, so it is also equally important to address these injuries with proper treatment as well. When numbness in the fingers is present, it implies that the nerves have been injured.
Treatment is dependent on many factors, such as age, activity level, prior hand injuries and other current medical problems. Your hand surgeon will determine which treatment is the most appropriate in your individual case. Some fractures are simple and well aligned with the bones and joints, which usually mean it will not require surgery. Severe bone fractures that fragment into multiple pieces may be badly displaced and will usually require surgical intervention. Some fractures are stable and will stay in place, whereas others are unstable and might shift during treatment so it requires casting.
A cast or splint will be used to treat a fracture that is not displaced, or to protect a fracture that has been set. A cast is usually worn for multiple weeks depending on the severity of the fracture and the ability to heal the broken bone.
Severe fractures may need surgery to properly set the bone and to stabilize the bones. Fractures may be stabilized with pins, screws, plates, rods, or external fixation. Plates and screws are placed through an incision on the wrist are used to hold the fractured bone in place. These implants are buried inside the wrist and do not require removal. External fixation requires placing a frame outside the body that is attached to pins that have been placed in the bone above and below the fracture site, keeping the bones in traction until the fracture heals.
Once the wrist has enough stability, motion exercises and physical therapy will be started for the wrist itself. Hand therapy is vital to help the wrist recover strength, flexibility and function.
Epicondylar fractures are common injuries in teens and young adults. Epicondylar fractures usually occur in males after a fall on an outstretched arm and represent 10% of all elbow fractures in young adults.
Medial epicondyle fractures comprise the majority of fracture injuries in teens and young adults. Most of these fractures can avoid surgical intervention and rather just be treated with splinting and physiotherapy. However, if the fracture is open, nerve disruption is occurring, or if their is a displaced fragment, most likely that patient will need surgical intervention to correct the fracture and then cast the area to limit movement which allows the bone and joint to properly heal.
Lateral epicondyle fractures are far less common type of fractures and are far less likely to require surgical repair or extensive treatment.
Medial epicondyle fractures
Medial epicondyle fractures represent almost all epicondyle fractures. Medial epicondylar avulsion fractures are the most common injury of the elbow and are usually seen in children and young adults.
Medial epicondyle fractures usually occur when an adolescent either falls on an outstretched hand with the elbow in full extension, a direct blow to the arm, or chronic injuries of the arm and shoulder throughout a young adolescents life contributing to a weaker bone and joint structure. However, by far the most common reason for a medial epicondyle fracture (accounts for two thirds of medial epicondylar fractures) is elbow dislocation that transmits the force to the medial epicondyle via the ulnar colateral ligament.
It is advised if an adolescent has an injury to the arm that they get an x-ray. A plain film x-ray will help determine if a medial epicondyle fracture is present. Some other indicaters of a fracture include soft tissue swelling and obvious displacement of the joint.
Treatment of a medial epicondyle fracture depends on both the particulars of the fracture and the age / size of the patient. An undisplaced fracture can be treated conservatively (3 weeks in an upper arm splint) with good results. For adolescents with minimally displaced fractures, those fractures can usually be treated with either cast immobilisation or an upper arm splint. Most displaced fractures will require surgery with internal fixation with a cannulated screw, which stabilizes the bone and joint and allows the area to heal in proper alignment.
Lateral epicondyle fractures
Lateral epicondyle fractures are rare epicondylar fractures and occur way less than medial epicondyle fractures. Lateral epicondyle fractures typically occur to young children than to adolescents. These injuries in children occur due to sudden traction of the arm. Lateral epicondyle fractures usually occur in adolesecents in the rare event of a direct blow to the elbow.
A plain film x-ray will determine in both making the diagnosis and determining treatment if a lateral epicondyle fractures is present. Undisplaced or minimally displaced lateral epicondyle injuries can be treated conservatively. In the event of a significant displaced fracture, surgery may be required in order to maintain rigid internal fixation, although conservative management for these patients also is an option. If the displacement has continued into the joint then surgical intervention is required.