Q: My granddaughter fell down the stairs and broke her elbow. They said it was a nondiplaced lateral condylar fracture (I wrote it down so I could ask you about it). They put her in a cast. Now what happens?
A: The goal of all treatment for this type of elbow fracture is to restore joint alignment as close to normal as possible. Bone fractures in children near a joint (the elbow in this case) raise additional concerns because of the potential to affect the growth plate and thereby stunt growth.
If the joint surface is disrupted (no longer lined up properly), treatment is directed toward realigning the bones and joint (called reduction). At the same time, the surgeon will stabilize the bone fracture (i.e., hold the bones together) while healing takes place. Fixation of the fracture is usually done with hardware such as a metal plate, screws, or wires.
In the case of a simple lateral condylarfracture (which is what it sounds like your granddaughter has) nonoperative care may be enough. The lateral condyle is the round end of the humerus (upper arm bone) that forms the upper part of the elbow joint. The arm is put in a cast or splint to immobilize it during healing. Close follow-up is important in order to make sure the bones keep their good alignment without displacement (separation), malunion, or malrotation.
So now the waiting begins. During the six to eight weeks it usually takes bones to heal in children, the surgeon will follow her closely to make sure (by X-rays) that everything is healing correctly in good alignment. Any sign that the bone fragments are separating, rotating, or cutting into the nearby soft tissues, blood vessels, or nerves will be cause for re-evaluating the treatment plan and possibly doing surgery.
When she comes out of the cast, the arm may be stiff but with regular movement and daily use, she will most likely regain her full motion and strength.
Reference: Kwan Soon Song, MD, and Peter M. Waters, MD. Lateral Condylar Humerus Fractures: Which Ones Should We Fix? In Journal of Pediatric Orthopaedics. June 2012. Supplement. Vol. 32. No. 1. Pp. S5-S9.
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