Elbow fracture (peds)

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

Medial epicondyle fracture (peds)

Background

• Not true Salter-Harris fx (apophysis, not physis, is involved)
• 50% assoc w/ elbow dislocation

Diagnosis

• Displacement of medial epicondyle ossification center
• May become entrapped w/in elbow joint
• Use CRITOE to determine if bone in joint is medial epicondyle or nl trochlear oss center
  • If think is trochlear but cannot see medial epicondyle fragment is medial epicondyle
    • (Medial epicondyle normally ossifies before the trochlea)
• Fat pad sign not usually present because most injuries are extra-articular

Treatment

• Ortho consult

Olecranon fracture (peds)

Diagnosis

• Often occur in a/w fx of radial head/neck

Treatment

• If displaced <5 mm immobilize in stable position (usually 45 degrees of elbow flexion)
• ORIF indicated for unstable fracture
• Orthopedic consultation is best to guide treatment

Radial head fracture (peds)

Management

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

See Also

• Elbow Diagnoses

Source

• Tintinalli
• UpToDate