Elbow Fracture in Children: Types, Diagnosis and Treatment

    Elbow fracture in children includes two important fractures that occur around the elbow joint. One of these is the fracture of the lateral condyle of humerus and the other is the Supracondylar fracture. Here on this page we will learn about the fracture of lateral condyle of humerus. Supracondylar fracture can be seen by clicking here.

    elbow fracture lateral condyle

    Lateral condyle elbow fracture in children occurs by a fall on the hand which creats a force that tends to wedge open the elbow joint. The lateral collateral ligament of the elbow joint becomes taut and pulls the lateral condyle of the elbow along with it as the force continues to act, resulting in the fracture. See the red arrows in the graphic. They show the direction of the force.

    Classification of this elbow fracture in children is on the degree of separation of the bone fragments.

    • Type 1 are undisplaced or minimally displaced fractures are those with less than 2mm gap between the fractured bone parts.
    • Type 2 are displaced fractures with greater than 2mm gap.
    • Type 3 are displaced fractures along with rotation of the bone fragment.

    elbow fracture lateral condyle classification

    Symptoms include pain, swelling and inability to move the elbow joint following injury. In undisplaced fractures the symptoms are mild whereas in displaced fractures they are more severe. There may be a delay in diagnosis of undisplaced fractures because the symptoms are mild. This may result in the fracture being labeled as a elbow sprain.

    Diagnosis is confirmed by taking a x ray of the elbow joint. A x ray of the opposite normal elbow may be required for comparison in very young children, because the bone is mainly cartilaginous and does not give a clear picture on x rays.

    Treatment depends upon the classification of the fracture.

    • Type 1 fractures are treated by immobilization of the fracture in a plaster splint.
    • Type 2 fractures are treated surgically. Stainless steel pins are used to stabilize the fracture under fluoroscopy.
    • Type 3 fractures are also treated surgically. A incision is given over the elbow. The fracture is exposed and aligned in proper position and stabilized with stainless steel wires.
    elbow fracture x ray

    elbow fracture x rays

    The above x rays show a Type 2 fracture. The red arrows show the fractured condyle.

    elbow fracture x ray

    This is a x ray of a Type 3 fracture. The black arrow points to the fractured lateral condyle.

    Many complications can occur after this fracture. They include the following

    • The fracture may fail to unite or there can be considerable delay in healing of the fracture. Failure to unite is called non-union. Many times this non-union can remain asymptomatic or may result in some weakness when performing unusual and demanding activities.
      It can also result in increasing deformity of the elbow joint called as cubitus valgus.
      In cubitus valgus the forearm and hand is shifted more outward as compared to normal. If this deformity is progressive then it can cause paralysis of the ulnar nerve.
    • Some children may develop the opposite deformity called cubitus varus in which the forearm and hand are shifted inwards more than normal.
    • Excessive bone formation may occur around the elbow joint causing limitation of motion.
    • Avascular necrosis or death of bone tissue following disruption of blood supply to the lateral condyle may develop. This usually occurs when extensive surgical dissection is required to align the fracture fragments.

    displaced lateral condyle elbow fracture type 2 lateral condyle elbow fracture post operative x ray lateral condyle elbow fracture

    These are x rays of a child who sustained a type 3 fracture (red arrow). His father was not ready for surgery so a reduction of the fracture was done. Next x ray was taken after the reduction. You can see that it has now changed to a type 2 fracture. About 2 weeks later I was able to convince him for surgery. The last x ray is of the fracture after surgery. You can see the two steel pins holding the fracture in aligned position.

    lateral condyle fracture 2 months old lateral condyle fracture old2

    This is a x ray of a 2 month old lateral condyle fracture. The fracture was treated by a quack who applied a plaster cast for 1 month. The patient came to me 1 month after removal of plaster, when the father noticed a bony lump and decreased movement in the elbow joint. It is a type 3 fracture. You can see that the fragment (enclosed within red semi-circle) has rotated by 90 degrees. To realign the fracture we had to rotate the fragment clockwise and push it, so that the yellow arrows overlap each other. Due to shortening of the ligaments (green line) there was difficulty in re-aligning the fracture. Only after release of the ligaments (green line), were we able to achieve a satisfactory reduction.

    Below is the post-operative x ray. Some gap remained. This was filled with callus (new bone which is formed to heal a fracture) obtained from the fracture site. See black arrow. Some deformity will persist, but hopefully fracture union will occur. This is the best that could be done without compromising the blood supply of the fragment.

    Frequently Asked Questions

    How long does it take for an elbow fracture in children to heal?

    The fracture usually takes 3 to 4 weeks to heal.

    How can complications be prevented?

    If your child has sustained an elbow injury. However innocent the injury may look you should take him/her to the doctor and get the elbow region x rayed. These fractures are known to be missed. A diagnosis of elbow sprain is made and the fracture goes untreated leading to complications.

    I hope the information provided on elbow fracture in children was helpful. If you have any query you can ask me at the contact me page.

    This page was last updated on 18th March 2011.

    Another important elbow fracture in children is Supracondylar Fracture

    Other causes of elbow pain...

    Tennis elbow

    Golfers elbow

    Olecranon bursitis

    Olecranon Fracture

    Radial Head Fracture

    Elbow dislocation

    Pulled elbow

    Little leaguer's elbow

    Elbow Joint Anatomy

    Elbow Fracture in Adults

    Go back from Elbow Fracture in Children to Elbow Pain


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