Pediatric Elbow Fracture

  • Etiology: trauma
  • Imaging:
    — 60% are supracondylar, 15% are lateral epicondyle, 10% are medial epicondyle
    — Elbow ossification (CRITOE 1,5,7,10,10,11) – Capitellum – 1 year, Radial head – 5 years, Internal (medial) epicondyle – 7 years, Trochlea – 10 years, Olecranon – 10 years, External (lateral) epicondyle – 11 years
    — Anterior humeral line through anterior cortex of humerus bisects middle third of capitellum on lateral view
    — Radial capitellar line parallel to and bisecting radial head and neck should bisect capitellum on all views
    — Anterior fat pad may be seen normally but not elevated, posterior fat pad should never be seen
  • Clinical: if fat pad elevation is present but fracture is not seen, treat as occult fracture + followup in 2 weeks

Supracondylar elbow fracture

  • Etiology: 95% are due to fall on outstretched hand hyperextension
  • Imaging: fracture line is above the condyles, joint effusion almost always present, see elevation of anterior or posterior fat pads, Gartland Type I is minimally displaced fracture, Gartland Type II is displaced distal fracture with intact posterior cortex, Gartland Type III has complete fracture fragment displacement
  • DDX:
  • Complications: malunion resulting in cubitus varus or fishtail deformity due to avascular necrosis of central portion of distal humeral physis and lateral trochlea
  • Treatment:
  • Clinical: most common elbow fracture type in children, 3-10 years old

Lateral epicondyle elbow fracture

  • Etiology: varus stress causes avulsion of common extensor tendon or LCL, fall on outstretched hand causing axial load and impingement of radial head
  • Imaging: often subtle, typically Salter Harris Type IV fracture, epiphyseal component may not be visible, Type 1 has < 2mm displacement, Type 2 has > 2 mm displacement, Type 3 has complete avulsion of fracture fragment
  • DDX:
  • Complications:
  • Treatment:
  • Clinical: second most common elbow fracture in children, 3-10 years old

Medial epicondyle elbow fracture

  • Etiology: acute valgus stress with flexor-pronator muscle contraction, fall on outstretched hand, arm wrestling, chronic valgus overuse
  • Radiograph: physeal widening and epicondylar rotation, up to 50% associated with elbow dislocation
  • DDX:
  • Complications: medial epicondyle entrapment due to a posterior elbow dislocation in 1/3rd to 1/2 of medial epicondyle fractures resulting in an “absent” ossification center
  • Treatment:
  • Clinical: third most common elbow fracture in children, 7-15 years old, most common acute fracture seen in adolescent throwing athlete, UCL is rarely ruptured

Radial head / neck elbow fracture

  • Etiology: compression of radial head against capitellum on valgus force
  • Imaging: radial neck fracture in children, radial head fracture in adults
  • DDX:
  • Complications:
  • Treatment:
  • Clinical:

Occult elbow fracture

  • Etiology:
  • Imaging: fat pad elevation is present and fracture is not seen
  • DDX:
  • Complications:
  • Treatment:
  • Clinical: if fat pad elevation present and fracture not seen, treat as occult fracture + followup in 2 weeks

Epiphyseal separation elbow fracture

  • Etiology:
  • Imaging: fracture through physis separates epiphysis from metaphysis, can look like posterior elbow dislocation on radiographs – epiphyseal separation more common in neonates and toddlers than traumatic joint dislocation
  • DDX:
  • Complications:
  • Treatment:
  • Clinical: in first few years of life – birth injury / accidental trauma / abuse

Radiology Cases of Elbow Fracture

Radiology Cases of Supracondylar Elbow Fracture

Radiograph of supracondylar elbow fracture
AP (left) and lateral (right) radiographs of the elbow show a fracture through the humeral metaphysis, above the condyles, along with elevation of the anterior fat pad on the lateral view.

Radiology Cases of Lateral Epicondyle Elbow Fracture

Radiograph of lateral epicondyle elbow fracture
AP (left) and lateral (right) radiographs of the elbow show a fracture through the lateral epicondyle and elevation of the anterior and posterior fat pads on the lateral view.

Radiology Cases of Medial Epicondyle Elbow Fracture

Radiograph of medial epicondyle elbow fracture
AP (upper left) and lateral (upper right) radiographs of the left elbow show inferior displacement of the medial epicondyle on the AP view and posterior displacement of the medial epicondyle and elevation of the anterior fat pad on the lateral view. The normal right elbow (below) is provided as a control.

Radiology Cases of Radial Head Elbow Fracture

Radiograph of radial head elbow fracture and olecranon elbow fracture
AP (upper left) and oblique (below) radiographs of the elbow show a complete fracture of the radial head with dislocation of the fracture fragment. Lateral radiograph (upper right) shows a lucency through the olecranon and elevation of the anterior fat pad.

Radiology Cases of Olecranon Elbow Fracture

Radiograph of olecranon elbow fracture
Lateral (above) and oblique (below) radiographs of the elbow show a lucency through the olecranon best seen on the oblique view along with elevation of the anterior and posterior fat pads.
Radiograph of radial head elbow fracture and olecranon elbow fracture
AP (upper left) and oblique (below) radiographs of the elbow show a complete fracture of the radial head with dislocation of the fracture fragment. Lateral radiograph (upper right) shows a lucency through the olecranon and elevation of the anterior fat pad.

Radiology Cases of Occult Elbow Fracture

Radiograph of occult elbow fracture
AP (left) and lateral (right) radiographs of the elbow show elevation of the anterior fat pad on the lateral view. No fracture line is seen.