This week’s guest columnist is Dr. Tasia Bradley, a Family Practice resident at the University Hospital and Clinics here in Lafayette.
I was two years-old. “Pick me up! Pick me up!” I yell to my sister. She grabs my hands, begins whirling me around, and up into the sky I go. “Faster! Faster!” Suddenly a pain in my left elbow. I begin to shriek as my sister lets me down, a puzzled look on her face, what did she do? Now Mom’s worried, she doesn’t know what happened either. On my first trip to the Emergency Department, the staff’s all smiles, no big deal, just a dislocation. 1…2..3.. back in place. Soon I’m running around again, but no more flying in the sky.
“Nursemaid’s Elbow” is an occasional event in toddlers, where a bone in the elbow gets dislocated. The forearm has two side-by-side bones, the radius and the ulna. Their ends near the elbow are held together by a rubber-band called the annular ligament. In some kids that ligament is weak, and the radial end can be pulled out of that loop by traction. Traction like being whirled around like me above, or having the hand jerked to hurry a slow toddler along. Sometimes it happens when a parent is trying to get a shirt off, tugging away at that long sleeve, and pop!
When children dislocate their radius, they cry at first, but then settle down. It looks benign- no swelling like with a broken bone, and kids often start playing again. Except that they’ve stopped using that elbow, letting it hang by their side, and do everything with the other arm. When parents bring them in, no x-rays necessary. If the story’s right (“Pulled on the wrist, eh?”), it’s a simple maneuver to put it in place. The elbow clicks like you’ve cracked a knuckle, a brief squawk from the child, and in a few minutes she’ll give you a high-five. Fixed!
To avoid this injury, of course, no tugging on hands and wrists. Pick up infants and toddlers under their armpits. But kids like being swung around, and they also can dislocate when wrestling or falling just so. When they pop that elbow, bring ‘em in. The good news: kids prone to Nursemaid’s Elbows develop stronger annular ligaments and stop dislocating by age 5.
Fast forward from 2 year-old Tasia above, to 1994. I’m on the playground at Boudreaux Elementary in Gretna, climbing the ladder to the monkey bars. Grab one bar, swing to the next, and the next, and….I’m falling through the air and land on my right arm. I’m crying, my elbow hurts so much. I went to my teacher, who wasn’t worried because there wasn’t any swelling, and by the end of the day I was using it again. No Emergency Department visit this time, but I’ve never been on monkey bars since. Just looking at them makes me break out in a sweat.
Sometimes though, kids end this scenario with a swollen elbow that just won’t stop hurting. Besides being vulnerable to dislocations as we discussed above, kids’ elbows are susceptible to fractures. The bone at the elbow end of the humerus (the upper arm bone) is thin. When kids land on their elbow, or impact on their outstretched hand, that bone end can crack. In fact, 70% of these fractures occur when the child falls and puts his hand out to brace himself. The force is transmitted through the forearm and snaps that vulnerable spot.
These injuries are more obviously bad than the Nursemaid’s elbow from above. The elbow is swollen and sometimes blue from internal bruising, and it really hurts. These need to be seen in the ER for x-rays, pain medicine, and treatment. Sometimes all that’s needed is a cast to hold the broken elbow still and protect it while it heals, usually 4-6 weeks. In some unlucky kids, however, the end of the humerus is cracked all the way through and shifted. These need surgery to pin that thin bone end back in place.
Finally, let’s briefly talk about the word “fracture.” Occasionally, a parent will be discussing their kid’s bone injury, and ask “is it broken or is it fractured?” This question puzzles us, since a fractured bone IS broken. It’s like asking “is the sky blue, or is it azure?” Fracture is just a fancy word for broken, and either way, it needs treatment, usually a cast, but sometimes surgery. Hopefully when your kid hurts their elbow, it will just be sprained like mine was, and get better in a matter of hours. But if it’s swollen and really painful, come on in!