Elbow fracture (peds)
Supracondylar Fracture
- 7% have nerve injury (median & radial most common)
- Can get ischemia due to brachial artery compression from increased compartment pressure
Diagnosis
- Anterior humeral line does NOT intersect middle third of capitellum
- Small anterior fat pad sometimes normal, posterior fat pad always abnormal
Classificiation
- Type I - Nondisplaced
- Type II - Displaced w/ intact posterior cortex
- Type III - no cortical contact
- On XR look @ development of secondary ossification centers (must occur in following order, age not as important, ie if see ossification of trochlea you MUST also see CRI as well!)
Treatment
- Type I
- Immobilize using a posterior splint and sling (extend from wrist to axilla)
- Refer to ortho within 1 week
- Type II & III
- Orthopedic consultation regarding closed versus open reduction w/ percutaneous pinning
- Admit
Lateral Condylar Fracture
Diagnosis
- Radiocapitellar line does NOT intersect the middle of the capitelum in all views
- May be only sign if fracture is entirely through the growth plate
- Fat Pad Sign
- May be only sign of nondisplaced fx
Medial Epicondylar Fractures
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 vs. normal 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
See Also
Ortho: Elbow Fracture
Ortho: Elbow (Minor)
Peds: Supracondylar
Rads: Elbow Xray Peds
Source
UpToDate