FRACTURES OF THE ELBOW IN CHILDREN

Among 300 fractures of the elbow in children, the most frequent type was the supracondylar fracture (177 cases, with marked displacement in 72 of these). The authors recommend skeletal traction as the primary treatment for this fracture if there is severe displacement; three weeks of traction are generally followed by two weeks of immobilization in a cast. Fractures of the lateral condyle (34 cases) require careful diagnosis because even a slight displacement of the capitellar epiphysis can result in deformity. Open reduction was necessary in 14 of these cases. Fractures of the medial epicondyle (27 cases) were accompanied by dislocation in 14 cases and by incarceration of a fragment of bone in the joint in 4 cases. Such incarceration must be watched for, since it calls for either excision or reattachment of the fragment. Fracture of the head of the radius (22 cases) was successfully treated by immobilization (15 cases) without severe displacement; others required either manipulation or open operation. The foregoing types of fracture are illustrated by four case histories. Gentleness in dealing with soft tissues is essential. Evidence of circulatory trouble demands prompt action. Restoration of function to injured nerves occurred in all cases but one. The expense and inconvenience of a few weeks of hospital care should not influence the choice of treatment, which largely decides whether the elbow is ever to regain normal form and function.