Differential diagnosis of pediatric elbow fractures

• Supracondylar elbow fracture
• Lateral epicondyle elbow fracture
• Medial epicondyle elbow fracture
• Radial head elbow fracture
• Olecranon elbow fracture
• Occult elbow fracture

Approach to the differential diagnosis of pediatric elbow fractures:

• Greater than 50% of pediatric elbow fractures are supracondylar and thus fairly easy to diagnose
• Knowledge of the order of elbow ossification (CRITOE) can help in elbow fracture diagnosis
• Always look for associated dislocations using the anterior humeral line and radial capitellar line when an elbow fracture is seen
• When in doubt, obtain radiographs of the contralateral elbow to look for elbow asymmetry / fracture in the symptomatic elbow
• Assume an occult elbow fracture is present when there is anterior or posterior fat pad elevation present without clear demonstration of a fracture line