DDX of pediatric elbow fractures

Approach to the DDX of pediatric elbow fractures:

  • Greater than 50% of pediatric elbow fractures are supracondylar and thus fairly easy to diagnose
  • Knowlege 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