Question 1

The X-ray shows a 'small crack' in my child's elbow and the doctor wants surgery—isn't that too aggressive for a small fracture?

Accepted Answer

Understandable to question surgery for what looks like a 'small crack,' but lateral condyle fractures are deceptively serious despite appearing minor on X-ray. Here's why surgery is often necessary: WHAT X-RAY DOESN'T SHOW: In children, much of the elbow is cartilage (not visible on X-ray). That 'small crack' you see in bone is often just the tip of the iceberg—the fracture likely extends through growth plate and joint cartilage which you can't see on X-ray. The actual fracture is usually much larger than it appears. DISPLACEMENT THRESHOLD: Any displacement more than 2mm requires surgery. Even 3-4mm looks 'small' on X-ray, but it's enough to cause problems. Why 2mm threshold? Because lateral condyle fractures involve joint surface—even small displacement causes steps/gaps in joint cartilage leading to arthritis. Also involve growth plate—poor blood supply to fracture fragment means nonunion (failure to heal) if not perfectly reduced and fixed. CONSEQUENCES OF UNDERTREATING: Nonunion (10-30% if inadequately treated)—fracture fragment doesn't heal, remains loose, causes chronic pain, instability, and requires complex revision surgery months later. Malunion—crooked healing causing permanent elbow deformity (cubitus valgus—elbow angled outward), risk of ulnar nerve problems (numbness in little finger) from stretched nerve. Arthritis—from irregular joint surface. These complications occur in 30-40% of lateral condyle fractures treated non-surgically when displacement more than 2mm. SURGERY VS CONSERVATIVE: Surgery (for displaced fractures)—85-90% excellent outcomes, 5-10% complications. Non-surgical (for displaced fractures)—30-40% develop nonunion/malunion, much higher need for delayed revision surgery. The numbers strongly favor surgery for displaced lateral condyle fractures. Yes, it seems aggressive, but it's evidence-based and prevents much worse problems down the track.

Question 2

My child had surgery 5 weeks ago and still can't straighten their elbow fully—is this permanent?

Accepted Answer

Elbow stiffness after lateral condyle fracture surgery is common and usually improves with time and physiotherapy—permanent stiffness is rare with proper treatment. Here's what to expect: NORMAL RECOVERY TIMELINE: Weeks 0-4 post-op—elbow in cast, deliberately immobilized. Expect significant stiffness when cast removed. Weeks 4-6—cast off, wires removed, start gentle range of motion. Expect to have 50-70% of normal motion at this point. Weeks 6-12—active physiotherapy, progressive improvement. Should regain 80-90% of motion by 12 weeks. Months 3-6—continued gradual improvement. Most children regain full or near-full motion (within 5-10 degrees of opposite elbow) by 6 months. FACTORS AFFECTING STIFFNESS: Age—younger children (under 8 years) regain motion faster due to remodeling. Older children (8-12 years) may take longer but still usually achieve excellent motion. Complexity—simple fractures with anatomic reduction regain motion better than complex comminuted fractures. Physiotherapy compliance—critical. Need to do exercises 2-3 times daily. WHAT TO DO: Week 5 is too early to predict final outcome. Continue intensive physiotherapy: Active range of motion (child moves elbow themselves, not therapist forcing it)—gentle stretching, reaching activities, ball games. Avoid passive stretching (therapist forcing elbow) in first 8-12 weeks—can cause re-injury or heterotopic ossification (abnormal bone formation causing more stiffness). Expect steady improvement over 3-6 months. WHEN TO WORRY: If stiffness not improving at all after 3 months of physio, or getting worse, may need assessment for: scar tissue contracture, heterotopic ossification, or malunion. Most cases resolve with conservative management. Surgical release of scar tissue rarely needed (less than 5% of cases) and only considered after 6-12 months of failed physio. Be patient—children's elbows have remarkable ability to remodel and regain motion even after prolonged immobilization.

Medical Disclaimer

Broken Outside Elbow Bone in Children (Lateral Condyle Fracture)

📖What is Broken Outside Elbow Bone in Children (Lateral Condyle Fracture)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention