Elbow injuries in children are extremely complicated orthopaedic problems to deal with and the diagnosis requires extensive experience as well as insight into the x-ray findings at various stages of a child’s elbow growth. In children, the injured elbow is often too painful and swollen to examine and the diagnosis rests with special investigations. Fractures or dislocations will require rapid assessment and treatment, due to the fact that the children are at high risk of developing swelling related complications such as compartment syndrome.
Elbow dislocations in children are usually not associated with any significant fractures. They require a closed reduction, usually under a general anaesthetic and early range of motion exercises. It is important to exclude a trapped pull-off (avulsion) fracture or a nerve in the joint – if this is missed, major complications will result.
Supracondylar fractures in children are extremely dangerous injuries and require urgent orthopaedic assessment and the more severe fracture grades must undergo emergency surgery.
There are at least six other common fractures around the elbow which occur commonly at various ages. Because large areas of the elbow are made up of cartilage until the mid-teens and are therefore invisible on X-ray, these injuries are frequently missed and written off as sprains or soft tissue bruising. It is imperative that children with injured elbows are reviewed by an orthopaedic surgeon. Many of these injuries are treated nonsurgically but correct immobilization and appropriate physiotherapy are required.
