Elbow Fractures in Children: Rehabilitation and Recovery Insights

Elbow fracture

Dear Director Li,
First of all, I must sincerely ask for the understanding of the Taiwan e-Hospital medical consultation team, as I only discovered this medical consultation platform yesterday.
I immediately sent an email to Dr.
Shih Kuo-Cheng and today I eagerly browsed through the questions posed by other doctors and related users, trying to resolve my confusion as quickly as possible, and I hope to receive some advice! However, if such repeated inquiries do not comply with the regulations or principles of the Taiwan e-Hospital medical consultation, I understand that I may not receive any responses.
My child was injured six months ago (January 31, 2023), suffering a laceration near the elbow joint of the left upper arm.
During the emergency treatment, two steel pins were inserted into the arm, and a cast was applied for five weeks.
One week after the cast was removed, rehabilitation began (which has been ongoing for six months).
To date, my child's left arm can be fully extended, but it can only bend to about 80 degrees (the angle between the upper and lower arm) and has not improved further.
Currently, my child can touch the top of their head and ear with their left hand, but if the left side of their neck itches, they cannot scratch it with their left hand!
Recently, I consulted another orthopedic doctor, who suggested the possibility of rehabilitation under anesthesia (is this what is commonly referred to as "joint mobilization"?).

Question 1: Could this medical approach cause any adverse effects, such as strains to nerves, ligaments, or muscles, or have any negative impact on the growth plates?
Question 2: How is the effectiveness of this medical approach assessed? For example, to what degree can elbow flexion be restored? How long will it take to see results? Will this rehabilitation be effective in one session, or will it need to be repeated multiple times over a certain period?
Question 3: Is this medical approach suitable for children? (My child is 5 years old.)
Question 4: Besides this method (rehabilitation under anesthesia), are there no other options available? If we do not proceed with this now, will my child's condition remain stagnant, or could it worsen?
Question 5: The original orthopedic doctor even mentioned that rehabilitation was unnecessary and that my child would naturally recover after the cast was removed.
Does this so-called recovery mean returning to the original state and function, or will there inevitably be some limitations?
Question 6: During the rehabilitation phase, doctors have stated that functional recovery is possible.
Given the situation described in Question 3, does this mean that the basic functional requirements have not yet been met?
Question 7: Since the rehabilitation therapists believe that there is little room for further improvement, does this imply that rehabilitation exercises can be stopped?
I hope you can understand my description, and I sincerely hope you can take the time to answer these questions or provide any suggestions for this anxious and depressed mother.
Thank you very much!

Youmu Mama, 30~39 year old female. Ask Date: 2006/07/18

Dr. Li Wenlin reply Orthopedics

Hello,
In response to your question, Director Shi may have already provided you with a satisfactory answer.
Here’s a brief response to your inquiries:
1.
Regarding your child's condition, rehabilitation therapy is generally not necessary.
Recovery of joint range of motion can occur through self-directed exercise, but it will take time—approximately six months.
Based on your description, your child's range of motion is about 100 degrees (the normal range for elbow motion is 135 degrees).
Joint stiffness has indeed developed.
There are two treatment options: the first is active rehabilitation, and the second is joint mobilization or surgery (open joint release surgery).
This method carries certain risks, such as the possibility of re-fracture due to excessive force or tearing of some tendons or fascia.
It is advisable to seek an experienced physician for this procedure.
2.
You already have sufficient information.
I personally recommend that you consult a specialist (pediatric orthopedic surgeon) for this situation.
Generally, pediatric humeral condyle fractures are not difficult to manage, but if there are complications, it would be best to seek advice from a pediatric orthopedic surgeon who specializes in treating such cases.
In Tainan, Dr.
Lin Qi-Zheng at Cheng Kung University, Director Qin Ling-Xiao at Chi Mei Hospital, and Dr.
Guo Ji-Yang at Kaohsiung Chang Gung Memorial Hospital are good options.
Bringing the X-rays and your child for an in-person consultation may provide you with more assistance.
Wishing you all the best!

Reply Date: 2006/07/18

More Info

Understanding elbow fractures in children, particularly in the context of rehabilitation and recovery, is crucial for both parents and healthcare providers. Your concerns regarding your child's recovery from an elbow fracture are completely valid, especially considering the complexities involved in pediatric orthopedic care.

Elbow Fractures in Children
Elbow fractures in children are relatively common, especially in active toddlers and young children. The healing process typically involves immobilization with a cast or splint, followed by rehabilitation to restore range of motion and strength. In your child's case, it seems that the fracture was treated with pins and a cast, which is a standard approach for more complex fractures.

Rehabilitation Process
Rehabilitation after an elbow fracture is essential to regain full function. The fact that your child can extend the arm fully but struggles to flex it beyond 80 degrees indicates that there may be some stiffness or potential issues with the soft tissues around the joint, such as the ligaments or muscles.
1. Importance of Rehabilitation: Rehabilitation is not just about physical therapy; it also includes exercises to improve flexibility, strength, and coordination. The goal is to restore the full range of motion and functionality of the elbow joint.

2. Joint Mobilization Techniques: The suggestion of "麻醉後復健" (rehabilitation under anesthesia) or "關節授動術" (joint mobilization) can be beneficial in cases where there is significant stiffness. This procedure allows the therapist to manipulate the joint while the child is under anesthesia, potentially breaking down any adhesions or scar tissue that may have formed during the healing process.

Concerns and Considerations
1. Potential Risks: While joint mobilization can be effective, it does carry some risks, including damage to surrounding nerves, ligaments, or muscles. However, when performed by experienced professionals, these risks are generally minimized. It is essential to discuss these concerns with your orthopedic surgeon to understand the specific risks involved in your child's case.

2. Effectiveness and Evaluation: The effectiveness of this procedure can vary. Some children may see significant improvements in their range of motion shortly after the procedure, while others may require multiple sessions. The recovery timeline can differ based on the child's age, the severity of the stiffness, and their overall health.

3. Suitability for Children: Given that your child is only five years old, this approach can be suitable, but it should be carefully considered. Children often have a remarkable capacity for healing and remodeling, so the decision should be made with a pediatric orthopedic specialist who understands the nuances of treating young patients.

4. Alternative Options: If you choose not to pursue the joint mobilization, there are still other rehabilitation strategies that can be employed. These may include physical therapy focusing on gentle stretching and strengthening exercises, as well as modalities like heat or ultrasound therapy to promote healing.

5. Natural Recovery: The idea that your child might recover naturally without rehabilitation is a common belief, but it is essential to recognize that while some children do regain function without intervention, many do not achieve full range of motion or strength without targeted rehabilitation.

6. Functional Goals: The goal of rehabilitation is to restore functional use of the arm. If your child is unable to perform basic tasks, such as scratching an itch on their neck, it indicates that further intervention may be necessary.

7. Stopping Rehabilitation: If therapists believe that there is limited potential for further improvement, it may be tempting to stop therapy. However, it is crucial to have a thorough discussion with the rehabilitation team to ensure that all options have been explored before making this decision.

Conclusion
As a concerned parent, it is understandable to feel anxious about your child's recovery. Open communication with your child's healthcare team is vital. They can provide personalized advice based on your child's specific situation and needs. It may also be beneficial to seek a second opinion from a pediatric orthopedic specialist if you feel uncertain about the current treatment plan. Remember, early intervention and consistent rehabilitation are key to achieving the best possible outcome for your child's elbow function and overall well-being.

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