Radial head fracture (peds)

This page is for pediatric patients; see radial head fracture for adult patients.

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

Radiograph-Negative

Pediatric

Evaluation

Workup

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

CRITOE.jpg

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
  • If any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present
    • The purpose of this is to see whether range of motion is restored after aspiration since if it is not, this may be an indication for surgery
    • This is generally not necessary to perform in the ED but can be done for patient comfort

Specific Management

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

Disposition

  • Consult ortho

See Also

External Links

References