Falls and throwing injuries are the two most common causes of medial epicondyle (elbow) fractures in children and teens between the ages of seven and 15. The medial epicondyle is located on the inside of the elbow. It is the place where several muscles and ligaments of the forearm attach (flexor muscles, pronator teres, medial collateral ligament).
The mechanism of injury is usually a valgus force on the elbow strong enough to pull these muscles and ligament off the bone taking with it a piece of bone. A valgus force goes from the lateral or outside edge of the elbow to the medial or inside of the elbow. This type of injury with a bone fragment attached to soft tissue is referred to as an avulsion fracture.
The child may feel or hear a popping sensation at the time of the injury. This will be followed by pain. Elbow dislocation is common and nerve damage is seen in up to 15 per cent of all patients with this type of fracture.
The goal of treatment is to heal the fracture, of course, but also to help the child regain normal motion, strength, and function. In the case of an athlete, return-to-sport and play at a preinjury level is ideal. The surgeon will use X-rays to guide the initial treatment decision.
Some children will be able to be treated with a conservative course of care (no surgery required). It sounds like this describes your nephew’s situation. If there are no complicating factors, he will likely be in the cast for four to six weeks. Reported results are usually quite excellent.
He will have to keep the cast dry, which limits water activities. In some situations (e.g., showering, possibly boating) a plastic bag can be taped around the arm to keep it dry. The hospital staff will give you a sheet of instructions. Follow those closely and report any new or unusual symptoms that might develop (hand swelling, finger numbness and tingling, cold fingers).