Elbow fracture (peds)

Supracondylar Fracture

• See Supracondylar Fracture

Lateral Epicondyle Fracture

Background

• Salter-Harris type IV Fx
• Neurovascular injury uncommon

Diagnosis

Clinical Findings

• Swelling and tenderness limited to lateral elbow

neurovascular injury is uncommon

Imaging

• Obtain oblique view if suspicion high despite neg AP/lat
• Radiocapitellar line won't intersect middle of capitellum in all views
  • May be only sign of fracture if fracture is entirely through growth plate
• +Fat Pad Sign/"sail" sign
  • May be only sign of nondisplaced fx

Treatment

• Often requires ORIF (ortho consult)

Medial Epicondyle Fracture

Background

• Not true Salter-Harris fx (apophysis, not physis, is involved)
• 50% assoc w/ elbow dislocation

Diagnosis

• Displacement of medial epicondyle ossification center
• May become entrapped w/in elbow joint
• Use CRITOE to determine if bone in joint is medial epicondyle or nl trochlear oss center
  • If think is trochlear but cannot see medial epicondyle fragment is medial epicondyle
    • (Medial epicondyle normally ossifies before the trochlea)
• Fat pad sign not usually present because most injuries are extra-articular

Treatment

• Ortho consult

Olecranon Fracture

Diagnosis

• Often occur in a/w fx of radial head/neck

Treatment

• If displaced <5 mm immobilize in stable position (usually 45 degrees of elbow flexion)
• ORIF indicated for unstable fracture
• Orthopedic consultation is best to guide treatment

Radial Head/Neck Fracture

Management

• Ortho consultation to guide treatment
• ORIF indicated when angulation >60 degrees or displacement >50%

See Also

• Elbow Diagnoses

Source

• Tintinalli
• UpToDate