Our 18-month-old son fell out of a wagon rolling down a small hill. He broke his elbow but the orthopedic surgeon was able to put it back together without surgery. The cast has been off for two months now, but he still seems to favor that arm and cries if we touch it. Sometimes he runs a low-temperature but it seems to come and go. What could be causing this?

There is no way to tell what is going on without a medical evaluation. The best thing to do is make an immediate appointment with your pediatrician or the surgeon who treated your son. The joint pain may be related to the previous injury or it could be something else.

Pain, skin or joint swelling, fever (even low-grade and intermittent) are all signs and symptoms of possible infection. Although very rare, children can develop a condition called septic arthritis of a joint. The condition can develop days, weeks, even months after an injury like this elbow fracture.

It may be necessary to X-ray the arm and a blood sample sent to the lab for analysis. Elevated white blood cells, sed rate, and/or C-reactive protein are tip offs that there may be an infectious process going on.

The X-ray will show if the fracture has been disrupted in any way. An MRI may be needed to look for abscess formation, unresolved hematoma (pocket of blood), or other changes in the bone, joint, or surrounding soft tissues.

Early diagnosis and treatment are important in order to preserve the joint and joint function. When caught early, treatment may be as simple as an antibiotic. If there is infection and pus within the joint, then cleaning that joint with a saline solution and removing any infection or dead tissue may be necessary.

But again, the first step is to get back into the physician’s office for an evaluation. Don’t jump to any conclusions until proper testing has been done to identify the problem and the underlying cause.