Elbow Fracture

  • Etiology: trauma
  • Imaging:
    — 50-70% are supracondylar, 10-15% are lateral epicondyle, 10% are medial epicondyle, 1-2% are medial condyle, occult elbow fracture
    — Supracondylar fracture – mechanism is FOOSH hyperextension, 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
    — Medial epicondyle avulsion – mechanism is acute valgus stress due to FOOSH or arm wrestling, chronic injuries in youth athletes
    — Lateral condyle fracture – Type 1 has < 2mm displacement, Type 2 has > 2 mm displacement, Type 3 has complete avulsion of fracture fragment
    — Radial head / neck fracture – mechanism is compression of radial head against capitellum on valgus force, radial neck fracture in kids, radial head fracture in adults,
    — 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
    — 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
    — Fat pad elevation due to hemarthrosis = occult fracture
  • Clinical: if fracture not seen, treat as fracture + followup in 2 weeks

Cases of Elbow Fracture