Elbow Fractures in Children

The elbow is a joint that consists of three bones – the humerus (upper arm bone), radius (forearm bone) and ulna (forearm bone) – that come together to form a complex hinge joint. An elbow fracture most commonly occurs when your child falls on an outstretched arm, commonly from monkeybars. The fracture usually occurs just above the joint.Fractures are common in children due to their physical activities as well as their bone properties. Children’s bones have an area of developing cartilage tissue called a growth plate which is present at the end of long bones that will eventually develop into solid bone as the child grows. These growth plates are particulatrly susceptible to injury.

X-rays are used to confirm and determine the type and severity of the fracture. Treatment of children’s elbow fractures depends on the degree of displacement and type of fracture:

  • Non-surgical treatment: If there is little or no displacement from the normal position, nonsurgical treatment is recommended. Your child’s doctor may immobilize the arm using a cast for 3 to 5 weeks. Regular X-rays are ordered to check if the bones are properly aligned, and stay aligned.
  • Surgical treatment: Surgery may be recommended if the fracture has caused the bones to move out of alignment. Your child’s doctor brings the bones into correct alignment and usually uses pins to hold the bones in place. Your child will have to wear a cast for a few weeks. Most of the time the pins can be inserted directly through the skin. Sometimes, however, an incision will need to be made in order to properly reduce the bone fragments, and then the pins are inserted to hold them in place. The pins are generally left in place for about 3 weeks. They are typically removed in the office. Exercises to improve the range of motion will be instructed once the bone is healed.

Forearm Fractures in Children

The forearm consists of 2 bones, the radius (bone on the thumb side) and the ulna (bone on the little-finger side). Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm. The growth plate, which is made of cartilage, is present at the ends of the bones in children and helps in the determination of length and shape of the mature bone. The growth plate is particularly susceptible to injury.

Forearm fractures can result from a fall onto an outstretched hand, or from a direct blow to the forearm. There is immediate pain, swelling, and often a deformity of the forearm is noticeable. Xrays are taken to evaluate the nature of the injury. At times just one of the two bones is broken, at times both are broken clean through, and at other times one breaks while the other one bends. Depending on the degree of displacement, angulation, and bending, treatment may involve placing the arm in a cast or splint, “setting” the bones under some form of anesthesia, or fixing the bones surgically, using pins or plates and screws. How and when to treat these injuries can vary on the child’s age in addition to the severity of the injury. Early evaluation allows for the best chance for optimal recovery, as delayed treatment in growing bones could be detrimental.

Wrist Fractures in Children

Wrist fractures are common in children, just as they are common in adults. As in adults, wrist fractures in children usually result from a fall onto an outstretched hand. Typical symptoms include pain, swelling, bruising, refusal to move the wrist or fingers, and sometimes an obvious deformity. Depending on the type and severity of the injury, and the level of maturity of the child’s bones, treatment can range from casting to surgery. The treatment recommendations in children can be significantly different from recommendations in adults. Up until the early teenage years (usually) children’s growth plates in the wrist are still open, and this allows for some significant remodelling of the bone after a fracture. This is more and more apparent, the younger the child is. Fractures that would clearly require surgery in an adult may be treated adequately with simple cast immobilization in a child. Early evaluation of these injuries, and thorough discussion with your doctor, is paramount to obtaining the most appropriate treatment for your child’s wrist.

Hand and Finger Fractures in Children

Finger fractures are common in children; hand fractures, less so. As in the elbow and the wrist, the growth plates at the ends of the bones are particularly susceptible to injury, but at the same time, the presence of an open growth plate indicates the possibility of remodelling. Symptoms of a fracture in the hand or fingers include pain, swelling, bruising, and refusal to move the fingers (even the ones that are not injured). These usually result from some sort of trauma, commonly a fall. Examination and xrays are used to determine if a bone is broken, and what type of treatment is indicated. Treatment options range from splinting and early motion, to “setting” the bone under some sort of anesthesia followed by splinting, to surgery to reduce the fracture anatomically. Early evaluation is of utmost importance, as children’s bones tend to heal faster than adults’, and the window for treatment, as a result, is smaller. If you are unsure if there is a break, it is always safer to have the child’s hand/finger evaluated sooner rather than later.

  • American Society for Surgery of the Hand (ASSH)
  • American Academy of Orthopaedic Surgeons (AAOS)
  • The American Board of Orthopaedic Surgery (ABOS)