Surgery · Fractures

Elbow fractures: the most delicate area in paediatric trauma

Some paediatric elbow injuries can be subtle but clinically important. Deformity, marked swelling or pain, neurovascular findings, or suspected displaced fracture require prompt assessment because the joint, nerves, vessels and growth plate may be involved.

Why the elbow has its own rules

More than elsewhere, here time-to-diagnosis and quality of reduction matter. A mistreated elbow leaves stiffness, axial deviations (cubitus varus or valgus) or neurological problems that are hard to correct later.

The most common surgical fractures

Supracondylar humeral fracture

In our practice, surgical patterns are preferably treated with closed reduction and percutaneous fixation using 2–3 Kirschner wires, choosing a lateral or crossed configuration according to fracture anatomy and stability. Immobilisation and wire removal are then planned according to clinical and radiographic follow-up.

The «classic» childhood fracture after a fall on the hand. More displaced forms (Gartland III) are often surgical; intermediate forms (Gartland II) are assessed case by case based on stability, alignment and fracture characteristics.

Median, ulnar and radial nerve function are checked before and after surgery. Speed of reduction matters, especially in forms with vascular compromise.

Lateral humeral condyle fracture

Reduction and fixation with K-wires or, in some cases, screws. Post-op cast.

Intra-articular fracture involving the growth plate. Even small displacements deserve special attention because of the risk of non-union and varus/valgus deviation.

Medial epicondyle fracture

Reduction and fixation with a screw or wires, depending on age and fragment size.

Significantly displaced forms, fragment trapped in the joint, elbow instability (often in adolescents and throwing athletes).

Radial neck fracture

Closed reduction is attempted; if angulation persists, percutaneous leverage reduction or ascending ESIN (Métaizeau).

Radial head angulations limiting pronation–supination, fragment instability.

What parents ask in clinic

Why can't a cast alone do the job?

Because many elbow fractures are unstable or intra-articular. A cast alone does not control fragment position and, on such a precise joint, inadequate alignment can translate into functional limitations.

Do K-wires stick out of the skin?

In some protocols yes, so they can be easily removed in clinic after a few weeks. They are protected with dressing and cast.

Will stiffness remain?

Some initial stiffness is normal and recovers over time. Persistent stiffness is less common when reduction is good and rehabilitation is gradual.

Nursemaid's elbow: a separate note

In young children, after a pull along the arm (yanked hand, lifted by the arms), you may see the classic picture of nursemaid's elbow: the child won't move the arm and holds it adducted. It is not a fracture, the diagnosis is clinical and, when the picture is typical, treatment is a medical reduction manoeuvre.

Other fracture sites

Wrist Forearm Humerus Femur Knee Leg Ankle Foot

For parents

Paediatric elbow fractures: information page

Context, checklist of clinical aspects and what to expect after the ER.

A second opinion on a paediatric fracture

Bring the ER report and the X-rays. A focused paediatric orthopaedic visit can clarify indication, timing and alternatives.

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Content for general informational purposes only. It does not replace a medical evaluation.