Types of Elbow Fractures in Children
The paediatric elbow is anatomically distinct from the adult elbow, with multiple secondary ossification centres appearing at predictable ages during childhood. This creates both diagnostic challenges on X-ray and unique fracture patterns that differ from adult injuries.
Supracondylar Fracture
The most common paediatric elbow fracture (~60%), occurring through the distal humerus just above the condyles. Typically caused by a fall on an outstretched hand. Vascular and nerve injury are important associated complications.
Lateral Condyle Fracture
The second most common type, involving the lateral condyle of the humerus. Carries a risk of non-union and growth disturbance if not treated appropriately.
Medial Epicondyle Fracture
An avulsion injury of the medial epicondyle apophysis, often associated with elbow dislocation. May require surgical fixation if significantly displaced or entrapped.
Assessment — Neurovascular Status Is Critical
Elbow fractures — particularly supracondylar fractures — carry a risk of vascular and neurological injury that distinguishes them from most other paediatric fractures. Urgent assessment of the circulation to the hand and the function of the surrounding nerves is mandatory at every point of contact.
- Vascular assessment — the brachial artery passes in close proximity to the fracture site; pallor, pulselessness, or a white cold hand warrants emergency surgical intervention
- Nerve assessment — the anterior interosseous nerve (AIN) is most commonly injured in supracondylar fractures, resulting in inability to make an “OK” sign; radial and ulnar nerve involvement may also occur
- Compartment syndrome — pain out of proportion, pain on passive stretch of the fingers, and a tense forearm are signs requiring urgent assessment to exclude compartment syndrome
Plain radiographs of the elbow in two planes are the standard initial investigation. The lateral view is particularly informative. CT may be required for complex or intra-articular fractures.
Treatment & Outcomes
Management depends on the fracture type, displacement, and neurovascular status.
- Minimally displaced fractures — managed in a splint or cast with close outpatient follow-up to monitor for displacement
- Displaced supracondylar fractures — the majority require surgical reduction and stabilisation with percutaneous Kirschner wires (K-wires) under general anaesthesia; the wires are typically removed in clinic after three to four weeks
- Lateral condyle fractures — displaced or unstable fractures require open reduction and internal fixation to achieve anatomical healing and prevent malunion
- Vascular compromise — constitutes an orthopaedic emergency; urgent surgical exploration is required
With timely, appropriate management, the majority of paediatric elbow fractures heal well and children regain full elbow function. Cubitus varus (medial angulation of the forearm — a “gunstock deformity”) is the most common late complication of a malunited supracondylar fracture and may require corrective osteotomy if functionally or cosmetically significant.
Discuss Elbow Fracture Management
For a personalised assessment and treatment plan, contact Dr. Pirpiris’s rooms at Cabrini Medical Centre, Malvern.
📞 Call 03 9508 9600