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.
- 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
++ Table Graphic Jump Location Table 1 Common Elbow Injuries in Children ||Download (.pdf)
Table 1 Common Elbow Injuries in Children
|Lateral condyle fracture||15%|
|Medial epicondyle fracture||10%|
|Radial neck or head fracture||8%|
|Complete epiphyseal separation (rare)|
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). ...