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Our little granddaughter (only nine years old) is quite a budding gymnast. But this week, she fell and broke her funny bone, which, as it turns out, is not so funny! They put her in a cast and didn't have to operate so we're thinking that's a good sign. But I'm wondering if there's a downside to all this. Will she, in fact, recover fully?
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From the studies done on medial epicondyle elbow fractures (of the "funny" bone), the chances are very good for full recovery when the fracture is not displaced (separated) and the joint is stable. Those are the two main criteria for placement of the arm in a cast.
Some surgeons warn that standard X-rays may not provide enough information when making the decision regarding surgery versus no-surgery. Specialized stress radiographic views and 3D-CT scans may be needed to obtain a full understanding of the type of injury/fracture present. In this way, significant trauma to the soft tissues around the elbow can be identified and treated as well. This approach helps avoid long-term complications from undiagnosed nerve damage, capsular involvement, or fragments of bone or cartilage in the joint.
When the cast was removed, a splint is usually worn for another two to four weeks during which time the athletes have someone move the arm for them three to five times each day. Active motion is allowed when the medial epicondyle (fracture site -- the bony bump along the inside of the elbow) is no longer tender to touch/pressure. Physical therapy may be needed if full elbow motion is still not present six weeks after conservative care was started.
A recent study from The Children's Hospital of Philadelphia comparing nonoperative versus operative care for these kinds of injuries showed that the results were very positive for both groups. This confirmed what the surgeons thought at the time of evaluation: careful patient selection for each type of treatment is important. The two main considerations were 1) injury mechanism (traumatic/high-energy versus nontraumatic/low-energy) and 2) elbow laxity or instability.
Children who had a nondisplaced fracture of the medial epicondyle without apparent joint laxity did well with conservative (nonoperative) care. Other young athletes with a high energy trauma elbow fracture with instability or laxity had good outcomes with operative care. All athletes in the study returned to full participation in their sport and were very satisfied with the results.
There were no cases of growth disturbance of the still growing children. That is always a concern with bony injuries in young athletes. Temporary, transient (comes and goes) numbness was reported by half of the patients treated with surgery. This symptom occurred most often when the elbow was fully flexed (bent) with compression and did not affect their sports participation. No one had any motor weakness at the final outcome (follow-up was a minimum of two years).
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