Anatomy
The elbow joint is formed by the humerus and one of the two forearm bones (ulna). The other forearm bone (radius) forms a joint with the ulna (species radioulnaris proximalis). Around the elbow joint is a joint capsule and several reinforcing ligaments. 
Elbow joint
A. Humerus
B. Capsula articularis
C. Epicondylus medialis
D. Lig. collaterale ulnare
E. Chorda obliqua
F. Ulna
G. Radius
H. Tendo m. bicipitis brachii
I. Lig. anulare radii
J. Lig. collaterale radiale
K. Epicondylus lateralis
Forearm bone from the front
A. Elbow
B. Ulna
C. Wrist
D. Radius
Cause
A direct fall on an outstretched arm or a blow can cause a fracture of the arm bones. In some cases, the fracture occurs in the growth zones (epiphysiolysis). In other cases, the bone ‘bends’ or fractures without breaking through (‘buckle fracture’, ‘green-stick fracture’).
The most common fractures of the humerus are fractures in the growth zone of the shoulder joint (epiphysiolysis colli humeri), spiral fractures and green-stick/buckle fractures in the centre of the humerus (corpus), various types of fractures around the elbow (fractura supracondylaris humeri, fractura epicondyli humeri, fractura condyli lateralis humeri, fractura capitulum humeri, fractura colli radii), fractures and green-stick/buckle fractures on the forearm and fractures in the growth zone at the wrist (epiphysiolysis).
Symptoms
Sudden onset of pain and pain-induced restriction of arm movement after a heavy load (fall). In severe cases, angulation of the arm may be seen.
Acute treatment
Relief until the medical examination
Examination
Sudden onset of severe arm pain with functional impairment after a fall should always lead to (urgent) medical attention. X-ray is the primary examination, but ultrasound scans are increasingly used to diagnose fractures (Endara-Mina J, et al. 2023). X-rays can usually show the fracture and determine treatment based on the type of fracture.
However, fractures are not always visible on X-ray, and if a fracture is suspected, ultrasound, MRI or CT scans should be used in addition. If the fracture occurs in the growth zones, it can be particularly difficult to see on X-ray
Treatment
Depending on the type of fracture, you can opt for bracing and possibly bandaging or surgery. Most elbow fractures require surgery (Raux S, Madelaine A. 2023).
Often adolescents with uncomplicated green-stick/buckle forearm fractures can return to contact sports after 4 weeks, while uncomplicated metaphyseal fractures (see figure) require an 8-10 week break and diaphyseal (corpus) and complete fractures require longer breaks before resuming contact sports. Complete diaphyseal fractures require even longer breaks from contact sports (Bhanushali A, et al. 2023).
Rehabilitation
The load and rehabilitation that can be allowed is entirely dependent on the severity and treatment of the fracture, which is why all rehabilitation should be carried out in close co-operation with the doctors supervising the treatment.
Once the pain has subsided, you can start cardio training in the form of cycling (primarily on a stationary bike) and running, as well as rehabilitation according to the guidelines under general rehabilitation for children. For surgical treatment, there are specific considerations that the surgeon will inform you about.
Complications
In the vast majority of cases, the fracture heals without complications. However, in a few cases there is delayed healing, development of a false joint (pseudoarthrosis), growth disturbances and possible impaired function of the arm and elbow (Endara-Mina J, et al. 2023).
In other cases, the fracture can affect the nerve supply or blood supply to the arm, which usually requires (emergency) surgery.
