Introduction
Elbow fractures are fractures of the elbow tip caused by a blow or a fall. These are the most common fractures seen in the pediatric population, accounting for 10 to 15 pecent of all cases worldwide. The fracture is distinguished by pain, swelling, and tenderness in the area of injury, resulting in an inability to raise the elbow or arm. Although elbow fracture is common, it is often unrecognized; thus, awareness in detecting elbow fractures is ideal. Proper assistance and management of these fractures are critical because they have the potential to compromise the neurovascular elements.
How Commonly Are Elbow Fractures Seen?
Elbow fractures are the second most common fractures and constitute around fifteen percent of all fractures occurring in children. It is commonly seen in children between the age of three to seven, with the highest occurrence rate around the age of six. This is commonly seen involving male and female populations, with an increased incidence in males.
How Does an Elbow Fracture Occur?
Elbow fractures occur due to trauma with wide stretched arms or fall with a direct hit on the elbow or arm. Factors causing elbow fractures are trauma, sports injury, fall injury, low bone density, calcium deficiencies, or abnormal twisting of the arm.
What Are the Types of Elbow Fractures?
These fractures are important as they can cause injury to the associated nerves and muscles. There are different types of elbow fractures seen based on the position, and they are:
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Supracondylar Fracture: This fracture involves the distal part of the humerus bone (bone of the upper arm) and is the most common type of elbow fracture seen, affecting almost sixty percent of the cases. This fracture type is considered an immature skeletal bone injury occurring between the ages of five and ten. Supracondylar injury, based on the mechanism of occurrence and displacement, is called an extension of the flexion type of fracture.
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Lateral Condyle Fractures: It is the second most common type (almost fifteen to twenty percent of the cases) of fracture seen in children. It has the highest incidence during the age of four to ten years. It involves the lateral condyle of the upper arm.
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Medial Epicondyle Fracture: These fractures are the third most common fracture type in children. This fracture occurs as an extra-articular fracture (fracture that does not involve a bony joint). It involves the posteromedial surface of the elbow and is commonly seen in children around nine to fourteen years old. The common cause of this fracture type is elbow dislocation or stress.
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Radial Head and Neck Fractures: Radial head fractures involve around one to five percent of elbow fractures in children. It is commonly seen between the age of nine to ten years. These fractures involve the epiphyseal and metaphyseal ends of the bone.
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Olecranon Fractures: These are among the most uncommon fractures in children associated with the radial head and neck.
How Is It Seen Clinically?
Elbow fractures are seen with sharp, excruciating pain associated with swelling or bruising on the skin. In addition, there will be stiffness of the joint with the inability to move the arm, visible arm deformity, an audible popping sound heard at the time of injury, and numbing of the arm, wrist, and hand due to compression in the blood vessels.
How Is an Elbow Fracture Evaluated?
Elbow Fractures can be evaluated using multiple diagnostic techniques. They are:
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Radiographic Imaging (X-rays) - X-rays are two-dimensional images used to identify any bony defect. In an elbow fracture, X-rays are taken in the front, back, and a side view to locate the fracture.
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Magnetic Resonance Imaging (MRI) - The MRI is a three-dimensional imaging technique used to detect any anomalies in the soft tissue surrounding the fracture site. The MRI scan of an elbow fracture reveals soft tissue and ligament injuries near the radial head.
How Is an Elbow Fracture Treated?
The treatment of all types of elbow fractures is the same, with slight variations depending on the location of the injury.
Non-Displaced Fractures: These are the type of fractures where the fractured segment is not displaced and is within the elbow compartment. In non-displaced fractures, surgical management is not required. The fractured segment is immobilized and stabilized using S-splint, keeping the elbow outstretched and forearm in a stable neutral position. The splint is removed, and casting is done once the swelling has subsided. The casting is removed three to four weeks after reviewing with an X-ray.
Displaced Fractures: These fractures are called so because the broken segment is displaced from the original position. This can be an open or closed fracture and is treated with surgical management. The surgical management of the fracture is as follows:
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In the case of a closed fracture, the reduction of the fractured segment is made by fixing it in the original position using metal pins, followed by casting.
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In an open fracture, the wound is surgically opened, and the fracture is fixed internally, followed by sling bandages and immobilization.
What Are the Conditions That Appear Similar to Elbow Fracture?
The conditions which appear similar to elbow fractures are
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Avulsion (loosening of the bone).
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Bursitis (inflammation of the fluid sac near the joint).
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Distal bone injuries of the hand.
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Fracture of the hand.
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Fracture of the forearm.
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Tendon ruptures near the elbow.
What Are the Complications of Elbow Fracture?
There are various complications associated with elbow fractures, and they are:
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Neuropraxia: Neuropraxia is the injury of the end nerves due to trauma.
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Vascular Injury: Vascular injury is the injury of the blood vessels occurring due to laceration of the soft tissue by a broken bone fragment.
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Compartment Syndrome: It is a clinical condition characterized by pain, swelling, and inflammation occurring due to pressure build-up due to infection during fracture management.
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Malunion: This occurs when the bone is not aligned during repositioning or immobilization.
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Non-union: This mainly occurs due to secondary infection during management or healing.
Conclusion:
Elbow fractures are commonly occurring fractures requiring a multidisciplinary approach involving general doctors, bone surgeons, X-ray specialists, physical therapists, etc. It is crucial to manage these fractures as they can compromise the nerves and muscles attached to them. Therefore, a lot of patients require extensive medical and surgical management along with physiotherapy to regain strength and motion. With periodic follow-up and strengthening, patients show favorable outcomes.
