Pediatric elbow fractures: a new angle on an old topic

Area of Science:

• Pediatric Orthopedics
• Pediatric Radiology
• Musculoskeletal Imaging

Background:

• Classical pediatric elbow fracture literature reports supracondylar fractures as most common (50-70%), followed by lateral condylar (17-34%) and medial epicondylar (10%).
• Proximal radius fractures, including radial neck fractures, are considered relatively uncommon (5-10%).
• This study's experience at a large children's hospital indicated a potentially different fracture distribution.

Purpose of the Study:

• To determine the frequency of various elbow fracture types in a large pediatric population.
• To identify elbow fracture types that are initially occult on radiographs but become apparent on follow-up imaging.

Main Methods:

• Retrospective review of medical records for 462 children diagnosed with elbow fractures over a 10-month period.
• Median patient age was 6 years (IQR 4-8 years).
• Initial and follow-up radiographs were independently reviewed by two pediatric musculoskeletal radiologists.

Main Results:

• The most frequent initial fractures were supracondylar (56%), radial neck (17%), and lateral condylar (15%).
• Olecranon fractures (7%) were significantly more common on follow-up radiographs than initially.
• 32 children had fractures detected on follow-up, with olecranon (72%) and coronoid process (13%) being most common.

Conclusions:

• The distribution of pediatric elbow fractures is different from historical reports, with supracondylar, radial neck, lateral condylar, and olecranon fractures being most common.
• Olecranon fractures are frequently occult and may be missed on initial radiographs.
• Careful evaluation of children with initially normal elbow radiographs is recommended to detect potentially occult fractures.