Radial head fracture (peds)

This page is for pediatric patients. For adult patients, see: radial head fracture.

Background

• Radial neck fractures tend to be more common in the pediatric population than radial head fractures
• Majority are Salter II fractures
• Average age is approximately 10 yrs

Clinical Features

• Mechanism is typically FOOSH
• Tenderness over the elbow
• May include posterior interosseous nerve intrapment causing a finger drop

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

• Distal humerus fracture
• Radial head fracture
  • Essex-Lopresti fracture
• Capitellum fracture
• Olecranon fracture
• Elbow dislocation

Radiograph-Negative

• Biceps tendon rupture/dislocation
• Lateral epicondylitis
• Medial epicondylitis
• Olecranon bursitis (nonseptic)
• Pronator teres syndrome
• Septic bursitis

Pediatric

• Nursemaid's elbow
• Supracondylar fracture
• Lateral epicondyle fracture
• Medial epicondyle fracture
• Olecranon fracture
• Radial head fracture
• Salter-Harris fractures

Evaluation

Workup

Radial head fracture (red arrow) with posterior and anterior sail sign (blue arrows).

• AP and lateral elbow xray
  • Assess for anterior fat pad

Diagnosis

Knowledge of ossification centers of the elbow can be helpful (see Elbow X-ray)

Elbow Ossification by Age (CRITOE)

Ossification Center	Age of Appearance (add 1yr for boys)
Capitellum	1yr
Radial head	3yr
Internal epicondyle	5yr
Trochlea	7yr
Olecranon	9yr
External epicondyle	11yr

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Specific Management

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

Disposition

• Consult ortho

See Also

• Elbow fractures (peds)
• Radial head fracture (Adult)