Elbow Fractures in Children: Diagnosis and Management

Fractures about the elbow are very common in children, but the anatomy of the child’s elbow may make the diagnosis less obvious than in a mature skeleton. An understanding of the ossification and fusion of the secondary growth centers about the elbow is essential to avoid overlooking these injuries and to optimize treatment. If plain radiographs are equivocal, an arthrogram of the elbow may clarify the anatomy and diagnosis. Early neurologic and vascular complications are not uncommon and must be recognized before fracture reduction. Many late complications, such as malunion, osteonecrosis, and physeal bridging, are largely preventable by correct early diagnosis and treatment. Anatomic reduction of articular surfaces, restoration of physeal anatomy, and near-anatomic alignment of fracture fragments in the frontal plane are the cornerstones of successful treatment of pediatric elbow fractures. Elbow fractures in children present the practicing orthopaedist with many challenges. The diagnosis may be difficult because a large portion of the elbow is radiolucent in very young children, and the physical examination of an uncooperative child with a grossly swollen elbow is problematic. Furthermore, both acute and long-term complications associated with these fractures are notorious. A thorough understanding of the anatomy of the immature elbow, as well as modern techniques of fracture management, maximizes the chances of a successful outcome.