My 12-year-old son broke his elbow in a weird sort of way — the round end of his upper arm (where it meets the elbow) broke. It wasn’t until a week later that we finally realized something was wrong and took him to the doctor. By that time, there was a big bump visible along the outside of his elbow. The doctor thinks it was a fracture that got worse over time and separated. Since he wasn’t treated until a week had gone by, will this affect the results?

It sounds like your son has a humeral lateral condyle fracture. Humeral refers to the upper arm bone. Lateral tells us it is on the outside of the elbow (medial would mean it was along the inside next to the body). Condyle is the term used for the round end of the humerus that helps form the upper portion of the elbow joint.

Pediatric humeral lateral condyle fractures make up 12 per cent of all elbow fractures in children. When it’s just a fracture without bone separation, treatment is with a cast or splint to immobilize the arm. The bone is kept still so it can heal and fill in the fractured area with new bone growth. If the end of the humerus starts to pull apart, it may be necessary to pin the two bones back together. Immobilization is still required until healing takes place.

But if the bones separate enough to disrupt the joint and the broken piece of the condyle twists or rotates away from the joint, then open surgery is needed. The surgeon will reduce the fracture (meaning put the bone pieces back together like a puzzle) and then wire them in place. Once again, a cast is put on the arm for about six weeks.

The results of this treatment can vary with complications occurring in some children. Those complications can be minor (e.g., infection treated with antibiotic) or major (fracture doesn’t heal or bone refractures). But just exactly why these complications occur isn’t always clear.

Your question is a reasonable one: will problems develop because treatment was delayed? Well, even if complications do occur, how would we know if it wasn’t because the force of the injury was severe enough to create additional problems later? Or maybe the age of the child and the stage of bone development was the defining factor in why complications developed.

At least one study from Children’s Orthopaedic Center in Los Angeles reported that there was no link between age, length of time between injury and treatment, or length of time in a cast and the final outcomes in over 150 children with this type of fracture requiring surgery. There’s still plenty of room for future studies to look into various factors that might increase the risk of poor results from cases like your son’s. Right now, the evidence doesn’t suggest that a delay in treatment necessarily means further trouble later.