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Anatomy

The elbow joint is composed of three bones that interact to enable bending, straightening, and rotating the forearm:

• Humerus: The upper arm bone extending from the shoulder to the elbow.
• Radius: The forearm bone on the thumb side that allows wrist rotation.
• Ulna: The forearm bone on the pinky side that functions as a hinge for elbow movement.

Types

There are several types of common elbow fractures:

• Occult Elbow Fractures: Common in growing children, these fractures may not be immediately visible on x-rays. They often present with swelling and pain, but later x-rays typically show healing bone. These fractures are generally treated with splints or casts and heal rapidly with improved comfort.
• Supracondylar Fracture: This occurs in the humerus just above the elbow and is the most frequent elbow fracture in children. Severe cases may require urgent surgery.
• Condylar Fracture: This type involves the joint surface of the humerus above the elbow, typically affecting the outer part of the elbow. Proper alignment of the joint surface is crucial, and these fractures may require a longer casting period and close monitoring due to potential healing issues.
• Epicondylar Fracture: Found at the bony prominences on either side of the elbow (medial or lateral). Medial epicondyle fractures can result from overuse or dislocations and may require specific attention.
• Physeal Fractures: These fractures affect the growth plate in the humerus, radius, or ulna. Improper treatment can lead to growth issues in the affected bone.
• Monteggia Fracture: Characterized by an ulna fracture and dislocation of the radial head. This injury often causes significant pain and swelling and may be diagnosed through physical examination and x-rays.

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Symptoms

Signs of an elbow fracture include deformity, swelling, acute pain, inability to move the elbow, and bruising. Severe cases may also present with numbness or tingling in the hand or forearm. Seek immediate medical attention if these symptoms are present.

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Diagnosis & Treatment

Examination

A doctor will assess the skin around the elbow, forearm, and wrist, and may gently move the joints to identify pain. Testing for nerve function and circulation is also crucial.

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Other Tests

X-rays are typically sufficient for diagnosing elbow fractures. If fractures are suspected in the forearm or if x-rays are inconclusive, additional imaging such as MRI, ultrasound, or arthrogram may be needed.

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Treatment

Treatment varies based on the fracture type and severity:

• Nonsurgical Treatment: For fractures with relatively good alignment, treatment usually involves a cast or splint for about a month. Follow-up x-rays may be needed to ensure the bones remain in place.
• Surgical Treatment: If alignment is poor, surgery may be required to realign the bones using pins, screws, or wires, often followed by casting or splinting for additional protection. Surgical hardware is typically removed once the bone heals sufficiently.

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Outcomes

Post-cast or post-surgery, some stiffness in the elbow or wrist is common but often resolves with time. Physical therapy may be needed to regain full motion. If fractures heal well and bones are properly aligned, the long-term outcome is generally excellent. Prompt medical attention can prevent complications such as improper healing or loss of motion.

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Most elbow fractures occur when a child falls on an outstretched arm with a lot of force from the fall. This impact can cause a fracture or break near the elbow.

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Common symptoms associated with elbow fractures include:

• Swelling
• Pain
• Limited movement
• Bruising around the elbow

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After the healthcare provider asks you and your child questions and does a physical exam, you’ll likely go to a room where an X-ray will be taken. The healthcare provider will examine the X-ray to determine the type of elbow fracture your child has.

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There are several types of elbow fractures. The most common include:

Supracondylar Fracture:

This is a break in the humerus bone, just above the elbow. These fractures are not only the most common elbow fractures in children under 8 years of age, but also the most serious since some of them can cause problems with circulation and nerve function. While the great majority of these fractures can be managed with manipulation and casting, the most severe one will require surgical manipulation and fixation with pins.

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Condyle Fracture:

These are breaks of the bony prominences of the elbow. The most common is a break on the outside or lateral condyle. If these fractures are displaced, they often require surgery to realign the joint properly.

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Fracture Dislocation:

A dislocation of the joint between the radius and the humerus with a fracture at the proximal aspect of the ulna bone is called a Monteggia fracture. These injuries require immediate attention. While the majority of them can be managed with a simple manipulation and cast application, some will require surgical fixation.

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Olecranon Fractures:‍

These breaks occur on the bony tip of the elbow. With little muscle or soft tissue covering the bone, it is a common fracture with direct trauma to the elbow.

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Radial Neck Fractures:

This is a break of one of the forearm bones near the elbow joint. This fracture is common in children who fall on an outstretched hand. The force of the fall is transmitted from the hand, up the arm to the elbow joint. These fractures are often managed with simple casting, reserving surgery only for those that are severely displaced or angulated.

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There are several different treatment options depending on the fracture and how severe it is. If the fracture is not displaced, a simple cast is likely to be applied for 3–6 weeks with periodic radiographs. If the fracture is displaced, a so-called “reduction” (pushing the bones back into place) will be required.

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If the reduction doesn’t work, or if the fracture is so severely displaced that a reduction would not be sufficient, surgery may be required. Surgery includes placing the bones back into place and then fixing them using pins, screws and/or wires. Most children regain their range of motion 1–2 months after the cast is removed. While in most cases physical therapy is not required, your doctor might decide to prescribe it if the condition is severe enough to require it.

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