Preksh Jain was two years old when he suffered an elbow fracture after a fall. It appeared to be an innocuous nature from which children walk away with minimal fuss, but that was not the case here.
At the time of the incident, Jain’s mother was not on the scene. On finding out, she tried to console him. “In some time, I realised there was no movement in the right hand [on which he landed]. I tried to throw him a ball, but he was not able to catch it. Seeing no movement in his hand, I immediately rushed him to the hospital,” his mother, Kusum Jain, recalls.
Elbow fracture is a common injury among kids, though its severity varies. Jain, for instance, had a compound fracture. However, his recovery was aided by the fact that his mother identified the injury quickly, and he received immediate medical attention.
Symptoms of elbow fracture
Jain had a supracondylar elbow fracture, which is commonly seen in kids. In this fracture, the break occurs in the humerus bone located above the elbow joint.
Dr Haridarshan GJ, consultant pediatrician, Apollo Hospitals, Bengaluru, lists the telltale physical symptoms of a fracture to watch out for in kids.
- Swelling of the hand, visibly identifiable when compared to the other hand
- Intolerable pain
- Abnormal hand movement
- Restricted movement
- Refusal to use the hand even for routine or effortless work
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Treatment of elbow fracture in kids
“The treatment depends on the extent of the injury and the type of fracture a kid has incurred,” says Dr Haridarshan. “It can be a simple fracture, or there might be complications in case of injuries caused by issues such as forceful collisions.”
In the case of simple fractures, the treatment modality revolves around keeping the bone/joint immobile in a cast to allow the crack to heal through mineralisation over time. For severe or compound fractures where the pieces of bones are shattered and out of place, surgery is recommended.
When a fracture occurs, the bone can form an ‘abnormal proximity’ (different position or alignment to the original one), which can affect the range of motion. This can eventually lead to excess swelling and callus growth. In such cases, the kid must undergo corrective surgery. It can also lead to non-union or malposition of bones if not treated accordingly.
In the case of Jain, doctors took an X-ray to determine the extent of the fracture. They advised immediate surgery (open reduction and internal fixation surgery or ORIF) as the bone was broken into multiple pieces.
While the fractures healed post-surgery, Jain is yet to get the joint aligned to the original position. This misalignment of bones post elbow fracture recovery is also a common occurrence among kids.
“As he grew up, his right hand was not properly aligned — when I consulted the doctor again, they asked me to wait to let it heal itself,” says Kusum, Jain’s mother. “If not, they recommended another operation at the age of 12.”
The waiting period, usually till the child has grown to 12 years of age, is suggested after accounting for the growing age (bone growth) of the child. The bone might align itself automatically as it grows, provided adequate exercise and activities are also done.
“For him [Jain], who is four years old now, activities which involve his hands and elbows, like dribbling, throwing and bouncing a ball were recommended to ensure good hand movements,” adds Kusum.
Recovery period for elbow fractures
Jain underwent ORIF surgery, where a K-wire (made of stainless steel or titanium) was placed in his right hand to keep the bones in place. After 21 days, the wire was removed and an external bandage was placed for support for 10 more days. The arm and elbow joint was then set free to check the range of motion, along with rehab/physio exercises. With time, his range of motion returned, but the hand remains misaligned.
Of course, not all fractures require this long a healing process. However, children go through intolerable pain when they have a fracture as well through the initial recovery phase. However, since it is the growing stage of their lives, the healing process is comparatively faster than adults. Parents can play a major role in reassuring the kids and giving them enough time to ensure a smooth recovery.
Takeaways
- Elbow fractures are common among kids, with supracondylar elbow fractures being the most widely seen type.
- The treatment depends on the severity of the fractures. In the case of a simple fracture, keeping the bone and joint immobile in a cast is the treatment modality. However, in the case of severe fractures where pieces of bones are out of place, surgery is recommended.
