Paediatric triceps avulsion fracture identified with ultrasound

Triceps avulsion fracture rupture is a rare tendon. Radiography remains the initial imaging modality of choice for evaluating a suspected triceps injury. However, in children the osseous insertion may not be visible on standard plain film imaging if it is partially ossified.

An 8-year-old child presented to Accident and Emergency complaining of localised pain over the right olecranon following a fall onto an outstretched hand. The X-rays did not reveal a visible fracture however with subtle radiological signs and objective clinical findings an ultrasound was sought demonstrating a visibly avulsed bony fragment.

This report demonstrates the importance of a thorough clinical examination needed to acquire a high index of suspicion as a missed or delayed diagnosis can lead to failure of surgical fixation resulting in prolonged disability.

The child underwent exploration under anaesthesia with anatomical reduction and fixation of the bony fragment with k-wires and periosteal sutures. Thereafter, following immobilisation in a cast the child regained full movement and power of extension.