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Treatment for Elbow Fractures in Children

Elbow fractures in children

TREATMENT

If an elbow fracture heals in the wrong position, the elbow may remain permanently crooked and have limited range of motion. For this reason, it is important that the fracture be treated correctly at the time of the initial injury.

Treatment for elbow fractures depends on the type of fracture and the degree of displacement.

Nonsurgical Treatment

Many stable fractures heal successfully with cast or splint immobilization. If the fracture is stable with no displacement, your doctor may directly apply a splint or cast to keep the bones in proper alignment while they heal.

Splints provide less support than casts; however, they can be easily adjusted to accommodate swelling from injuries. In many cases, a splint is applied to a fresh injury first. As swelling subsides, a full cast may replace the splint.

In some stable elbow fractures, the bones may need to be repositioned before applying a splint or cast. In this procedure—called a closed reduction—your doctor gently moves the arm to manipulate the bones back into place. Your child will be given some form of sedation or anesthesia for this procedure.

Your doctor may schedule additional x-rays to make sure the bones stay in place as they heal.

Surgical Treatment

If the bone fragments are displaced, surgery may be required to ensure that the fracture heals fully.

Closed reduction and percutaneous pinning. In this procedure, the displaced bone fragments are repositioned during closed reduction and held in place with metal pins. The pins are inserted through the skin, into the bone and across the fracture. A splint is applied to protect the area for the first week, then is typically replaced with a cast. The pins and cast are removed after healing has begun, a few weeks after surgery.

Open reduction and internal fixation. Open fractures, fractures that cannot be repositioned during a closed reduction, and fractures that are accompanied by nerve or vascular injuries require open surgery or open reduction and internal fixation.

 
Internal fixation of elbow fracture
This x-ray shows a supracondylar humerus fracture that has been put into the correct position and held in place with two pins. The pins will be removed after healing has begun.
Reproduced from Surgical management of pediatric fractures in the upper extremity, Flynn J, Sarwark J, Waters P, Bae D, Lemke L: Instr Course Lect 2003, 54: 635-645.

 

Recovery

Whether the fracture is treated by simple immobilization or with surgery, the arm will be placed in a cast or splint for 3 to 6 weeks, depending upon the fracture.

When the fracture is healed well enough, the doctor may recommend specific exercises to improve the range of motion in the joint.

In most cases, the elbow’s range of motion returns to normal, or has just a mild limitation.

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