Pediatric Elbow Fracture | Pediatric Radiology Reference Article | Pediatric Imaging

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

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