PEDIATRIC ELBOW INJURIES Flashcards
Elbow Imaging: Name the ossification centers and the age of appearance
CRITOE
Capitellum: 1 yr
Radius: 3 yr
Internal (Medial) Epicondyle: 5 yr
Trochlea: 7 yr
Olecranon: 9 yr
External (Lateral) Epicondyle: 11 yr
What are the signs of effusion on elbow imaging?
Sail Sign: anterior fat pad sticks out bigger than normal “like a sail.”
Posterior Fat Pad: always abnormal. Suggestive of an effusion or fracture.
Describe the anterior humeral line on elbow imaging. What do you consider if it is abnormal?
Line drawn down anterior cortex of the humerus on the lateral view should bisect the capitellum in the middel 1/3. Otherwise consider supracondylar fractures.
Describe the radiocapitellar line. List the DDx if it’s abnormal.
Line drawn along the central shaft of the proximal radius should pass through the capitellum on all views.
DDx if abnormal:
Radial head dislocation
Elbow dislocation
Lateral condyle fracture
Radial neck fracture
Radial Head Subluxatoin (Pulled Elbow): Mechanism
Sudden axial traction on extended arm, often pulled on the hand by someone taller -> Radial head slips under the annular ligament
May be no history of trauma
Radial Head Subluxatoin (Pulled Elbow): Clinical Features
Child who suddenly refuses to use arm
Usually flex and pronated, may be supported by the other arm
No signs of swelling, erythema, deformity
Neurovascular assessment is normal
Radial Head Subluxatoin (Pulled Elbow): Management
Hyperpronation with flexion: better first time success rate
Supination with flexion
May hear or feel a click
Observe for 30 min; child should use arm normally within 30 min
Supracondylar Fracture: Mechanism
Most commonly fall on ourstretched hand when arm is hyperextended -> posterior displacement of anterior humeral line
Supracondylar Fracture: Types and xray features
Type 1: non-displaced
-Fat pads prominent, slight disruption of the figure of 8
Type 2: displaced
-Displacement of the anterior humeral line
Type 3: displaced with no cortical contact
Supracondylar Fracture: Management of each Type
Type 1: No reduction required, long arm back slab with elbow at 90 degrees with sling
Type 2 & 3: Orthopedic consultation for operative management
Beware of compartment syndrome, arterial injury or nerve injury
Lateral Condyle Fractures: Mechanism
Varus stress to an extended elbow with forearm supination
Lateral Condyle Fractures: Clinical Features
Large amount of swelling on lateral aspect of the elbow
Lateral Condyle Fractures: XRAY Features
XRAY may look benign. Non displaced easily missed.
If clinical suspicion is high, get oblique view.
> 2 mm displacement require reduction and fixation
Lateral Condyle Fractures: Management
All unstable
Emergent orthopedic referral
Radial Neck Fracture: Mechanism
Fall on extended elbow with a valgus force to forearm -> radial head is cartiligenous in children therefore neck at risk of fracture
