Post-Surgery Complications After Elbow Growth Plate Fracture in Children

Q: Post-Surgery Complications After Elbow Growth Plate Fracture in Children

Hello： In response to your question, based on your description, your son likely has a fracture of the right humeral condyle, either the medial or lateral epicondyle. <br>The surgical treatment has been very effective and is less likely to result in long-term complications. <br>Ad

What are the potential complications after surgery for a fractured growth plate in the elbow?

Hello, Director Li:
A five-year-old child fell on January 12 of this year, resulting in a fracture of the growth plate in the right elbow.
The child was taken to the hospital, where surgery was performed to insert two steel pins for stabilization, followed by rehabilitation.
It has been over three months, and the function of the right hand is relatively normal.
However, the injured growth plate is still slightly prominent, causing the right arm to not extend as straight as the left.
The treating physician mentioned that the prominent part will gradually diminish, but the timeline for this is uncertain.

I am also very concerned about whether the injury to the growth plate will affect the future growth of the child's arm (could it lead to discrepancies in arm length?).
Are there any other potential long-term complications?

Hayden, 40~49 year old female. Ask Date: 2006/04/21

Dr. Li Wenlin reply Orthopedics

Hello: In response to your question, based on your description, your son likely has a fracture of the right humeral condyle, either the medial or lateral epicondyle.
The surgical treatment has been very effective and is less likely to result in long-term complications.
Additionally, pediatric bones have a significant capacity for remodeling, and they can return to their normal shape within as little as three months to as long as a year.
However, injuries to the growth plate can lead to complications such as growth retardation or cessation, which may result in issues like limited elbow extension, hyperextension, or varus/valgus deformities.
While it is understandable to be concerned about these potential outcomes, it may not be very beneficial to dwell on them at this stage.
I personally recommend that you ensure your son has regular follow-up appointments.
If necessary, the attending surgeon can determine whether rehabilitation therapy is required.
I believe this approach will help achieve the best treatment outcomes.
Wishing your son a speedy recovery!

Reply Date: 2006/04/21

More Info

When a child suffers a growth plate fracture in the elbow, it can lead to various complications and concerns regarding future growth and function. In your case, your five-year-old son experienced a fracture that required surgical intervention, including the insertion of two pins for stabilization. While he has shown some recovery, the presence of a protruding growth plate raises valid concerns about potential long-term effects.

Post-Surgery Complications
1. Growth Plate Injury: The growth plate, or epiphyseal plate, is crucial for the longitudinal growth of bones. Injuries to this area can lead to complications such as growth disturbances. If the growth plate is damaged, it may result in conditions like premature closure, which can lead to discrepancies in limb length (e.g., one arm being shorter than the other). This is particularly concerning in children, as their bones are still growing.

2. Malunion or Nonunion: After a fracture, there is a risk that the bone may heal improperly (malunion) or not heal at all (nonunion). Malunion can lead to deformities, such as the inability to fully extend the arm, which you have observed. Nonunion may require further surgical intervention to correct.

3. Joint Stiffness and Reduced Range of Motion: Post-surgical stiffness is common, especially in the elbow, which is a complex joint. Rehabilitation and physical therapy are essential to restore function and range of motion. If the protruding growth plate does not resolve, it may contribute to ongoing stiffness or functional limitations.

4. Arthritis: In some cases, injuries to the growth plate can predispose the joint to early-onset arthritis, particularly if the joint alignment is affected due to improper healing.

Monitoring and Management
Your child's doctor has indicated that the protruding part of the growth plate may gradually resolve, but the timeline for this is uncertain. Regular follow-up appointments are crucial to monitor the healing process and assess any changes in the growth plate's appearance and function.

1. Regular Check-ups: It is essential to maintain regular follow-ups with the orthopedic specialist. They will monitor the growth plate's healing and assess the overall function of the elbow. X-rays may be necessary to evaluate the growth plate's condition over time.

2. Physical Therapy: Engaging in a structured rehabilitation program can help improve range of motion and strength in the affected arm. A physical therapist can provide exercises tailored to your child's needs.

3. Nutritional Support: Ensuring your child has a balanced diet rich in calcium and vitamin D can support bone health and growth. Adequate nutrition is vital for recovery and overall development.

Long-term Considerations
While it is natural to worry about the potential for growth discrepancies or other complications, it is important to focus on the present and follow the recommended treatment plan. Many children recover well from growth plate injuries, and their bones can remodel effectively over time.
If there are concerns about significant growth discrepancies as your child continues to grow, further interventions may be considered in the future, such as growth modulation procedures. These are typically reserved for cases where there is a clear and significant difference in limb length.

In conclusion, while there are potential complications associated with growth plate fractures, proactive management and regular monitoring can significantly mitigate risks. Your child's orthopedic team will be the best resource for addressing any ongoing concerns and ensuring optimal recovery.

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