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A 7-year-old girl fell off “monkey bars” on to her outstretched right hand. She complained of pain localized to the right elbow.

On examination, there was diffuse swelling and tenderness about the elbow. She was unable to flex the elbow more than 30°. The remainder of the right upper extremity was normal.

The elbow radiographs are shown in Figure 1.

Figure 1

[From: Rogers LF: The Radiology of Skeletal Trauma, 3rd ed. Churchill-Livingstone, 2002, with permission.]

  • Are any abnormalities present?
  • What is the third most common fracture about the elbow in children?

Without a clear understanding of the radiographic landmarks and injury patterns in children, the findings in this patient are difficult to appreciate, even though this child has a major injury that will require surgical treatment.

Although comparison views are often obtained in children, the correct diagnosis can be made in this patient using the radiographs of the injured side alone.

Fractures of the elbow are among the most common extremity injuries in children. However, they can be difficult to diagnose due to the complex developmental anatomy of the elbow and the subtle radiographic manifestations of some injuries. Comparison views are often obtained to aid radiograph interpretation, although by knowing the principal anatomical landmarks and injury patterns, the diagnosis can be made in many cases using radiographs of the injured side alone (Table 1).

Table 1 Common Elbow Injuries in Children

Fractures are often difficult to detect in young children because much of the elbow is not ossified. In addition, the pliable cortical bone in children may be deformed without a discrete fracture line (acute plastic bowing) or have a fracture on only one side of the cortex (a greenstick fracture). Such fractures can often only be detected by noting malalignment of the bones of the elbow.

There are two key landmarks of alignment that are useful in detecting elbow injuries in children—the anterior humeral line and the radiocapitellar line. In addition, the location and the sequence of appearance of the six ossification centers of the elbow must also be understood because they are often involved in elbow injuries. The growth plates do not fuse until late adolescence and these can be difficult to distinguish from fractures.

There are three distinctive elbow injuries in children: supracondylar fractures, lateral condylar fractures and medial epicondylar avulsion fractures (Table 1). ...

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