Pediatric 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 children, 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 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
    — Fat pad elevation due to hemarthrosis = occult fracture
  • Clinical: if fracture not seen, treat as fracture + followup in 2 weeks

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.