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Broken Elbow

  • Overview

    Broken elbows in children

    Read the information in the following pages to learn more about the diagnosis and treatment that Boston Children's Hospital provides for every type and severity of broken elbow in children.

    What are broken elbows?

    A broken elbow is a break, at or near the elbow joint, in one or more of the three arm bones that form the joint: the humerus (upper arm bone), radius and/or ulna (forearm bones).

    Pediatric elbow fractures are usually the result of an impact injury, like in a direct blow, or when a child uses his outstretched arm to break a fall. A fractured elbow is typically treated by splinting or casting the area for about four weeks.

     

    Broken elbow: Reviewed by Travis H. Matheney, MD, MLA
    © Boston Children’s Hospital, 2012

     

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    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115

    617-355-6021

  • In-Depth

    What are the types and locations of elbow fractures?

    Because the elbow is such a complex joint, one way to classify elbow fractures is by their location in or around the joint. Some elbow fracture locations include:

    • Above the elbow(supracondylar humerus fracture): occurs when the upper arm bone (humerus) breaks just above the elbow. This is the most common elbow break in younger children.
    • At the elbow “knob”(condylar fracture): a break through one of the bony knobs (lateral and medial condyles) at the end of the humerus
    • At the elbow tip(epicondylar fracture): a break at the end of the humerus, near the bony knob that makes up the tip of the elbow. This is common in pre- and early-adolescent children.
    • At the growth plate(physeal fracture): a break that occurs at, into or across a growth plate (soft pieces of developing  cartilage tissue from which bone grows)
    • At the elbow end of the radius(radial neck fracture)

    A dislocation of one of the joints of the elbow can accompany one of the above fractures, and if present, will be addressed at the same time as treatment of the fracture.

    Learn more about the different types of fractures in children

    Causes

    What causes broken elbows in children?

    A bone breaks when there’s more force applied to the bone than it can withstand. These breaks can occur from falls, trauma or a direct blow. Most childhood fractures result from mild to moderate (rather than severe) trauma that happens while children are playing or participating in sports, with the rate of fractures peaking in adolescence, especially among boys.

    Certain risk factors may also increase a child’s chances of breaking an elbow

    Signs and symptoms

    What are the signs and symptoms of broken elbows in children?

    • Common signs of a broken elbow include:
    • Pain or swelling in the elbow or forearm
    • An obvious deformity in the elbow or forearm
    • Difficulty moving, flexing or extending the arm normally
    • Warmth, bruising or redness at or near the elbow
  • Tests

    How are broken elbows in children diagnosed?

    To diagnose broken elbows in children, the doctor will carefully examine the injured area for tenderness, redness and swelling.

    One or more of the following imaging techniques may also be used to get pictures of the broken bone and to check for damage to muscles or blood vessels.

    X-ray

    • An x-ray of the elbow is the main tool used for diagnosing a broken bone. This test uses small amounts of radiation to produce images of a child’s bones.
    • After the doctor puts the pieces of the broken bone in the right position, an x-ray can also help determine whether the bones in the elbow/arm are healing in the proper position.


    Other diagnostic tools include:

    • Magnetic resonance imaging (MRI): Some fractures (such as stress fractures), don't show up on an x-ray until a few weeks after the bone starts hurting. An MRI is a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. These types of tests are more sensitive than x-rays and can pick up smaller fractures before they get worse.
    • Computed tomography scan (CT, CAT scan): a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body.
    • Bone scan: a painless procedure that uses a radioactive substance to detect changes in joints and bones and determine the cause of unexplained pain. Bone scans are useful for detecting stress fractures and toddler’s fractures, which can be less visible on x-rays.
  • The treatments for broken elbows in children depend on the location and severity of the fracture as well as the child's age and overall health.

    How are broken elbows in children treated?

    In most cases, broken elbows in children are treated with a splint or cast, which immobilizes the injured bone(s) to promote healing and reduce pain and swelling.Splints and casts may also be put on after surgical procedures to ensure that the bone is protected and in the proper alignment as it begins to heal.

    • Splints are used for minor breaks. Splints support the broken bone on one side and immobilize the injured area to promote bone alignment and healing. Splints are often used in emergency situations to hold a joint in a steady position during transportation to a medical facility.
    • Casts are stronger than splints and provide more protection to the injured area. They hold a broken bone in place while it heals by immobilizing the area above and below the joint. Casts have two layers: a soft inside layer that rests against the skin and a hard outer layer that prevents the injured bone from moving.

    Some common types of casting for broken elbows include:

    Click to enlarge

    TYPE

    LOCATION

    USES

    Long arm cast

    Applied from the upper arm to the hand

    Upper arm, elbow or forearm fractures; also used to hold the arm or elbow muscles and tendons in place after surgery

    Arm cylinder cast

    Applied from the upper arm to the wrist

    To hold the elbow muscles and tendons in place after a dislocation or surgery

     

     

    Other treatments for broken elbows include:

    • Surgery may be needed to put broken bones back into place. A surgeon may insert metal rods or pins located inside the bone (internal fixation) or outside the body (external fixation) to hold bone fragments in place to allow alignment and healing. This is done under general anesthesia.
    • Traction corrects broken or dislocated bones by using a gentle and steady pulling motion in a specific direction to stretch muscles and tendons around the broken bone. This allows the bone ends to align and heal, and in some cases, it reduces painful muscle spasms.
    • Closed reduction is a nonsurgical procedure used to reduce and set the fracture. Using an anesthetic (typically given through an IV in the arm), the doctor realigns the bone fragments from outside the body and holds it in place with a cast or splint.
    • Physical therapy may be needed to strengthen the arm, restore range of motion and help the arm return to full function after treatment and/or casting.
  • Research & Innovation

    The General Orthopedic Program, located within the Orthopedic Center at Boston Children's Hospital, takes great pride in our basic science and clinical research leaders, who are recognized throughout the world for their respective achievements. 

    New trauma/ER database

    Under the direction of Travis Matheney, MD, MLA, Boston Children’s database of orthopedic ER trauma cases has begun outcomes research. Implemented in July, 2010, we track/compile orthopedic trauma data, such as:

    • Type and location of fractures (such as an end-of-the-radius/wrist fracture)
    • Outcome (quality improvement)
    • Did the injury require admission to the hospital
    • How was the injury initially treated

    The information gathered from this ongoing tracking study will further influence how specialists in Boston Children’s Orthopedic Trauma Program care for children by providing accurate, comprehensive tracking and outcomes data.

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