Pediatric Radiology

, Volume 45, Issue 6, pp 814–819 | Cite as

Fishtail deformity — a delayed complication of distal humeral fractures in children

  • Srikala Narayanan
  • Randheer Shailam
  • Brian E. Grottkau
  • Katherine NimkinEmail author
Original Article



Concavity in the central portion of the distal humerus is referred to as fishtail deformity. This entity is a rare complication of distal humeral fractures in children.


The purpose of this study is to describe imaging features of post-traumatic fishtail deformity and discuss the pathophysiology.

Materials and methods

We conducted a retrospective analysis of seven cases of fishtail deformity after distal humeral fractures.


Seven children ages 7–14 years (five boys, two girls) presented with elbow pain and history of distal humeral fracture. Four of the seven children had limited range of motion. Five children had prior grade 3 supracondylar fracture treated with closed reduction and percutaneous pinning. One child had a medial condylar fracture and another had a lateral condylar fracture; both had been treated with conservative casting. All children had radiographs, five had CT and three had MRI. All children had a concave central defect in the distal humerus. Other imaging features included joint space narrowing with osteophytes and subchondral cystic changes in four children, synovitis in one, hypertrophy or subluxation of the radial head in three and proximal migration of the ulna in two.


Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment.


Fishtail deformity Trochlea Avascular necrosis Magnetic resonance imaging Distal humeral fracture Radiography Children 



The authors would like to thank Noemi Chavez and Eleni Balasalle for their assistance with manuscript preparation.

Conflicts of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Srikala Narayanan
    • 1
    • 2
  • Randheer Shailam
    • 1
  • Brian E. Grottkau
    • 3
  • Katherine Nimkin
    • 1
    Email author
  1. 1.Department of Radiology, Division of Pediatric ImagingMassachusetts General HospitalBostonUSA
  2. 2.Department of RadiologyUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Department of Orthopaedics, Pediatric OrthopaedicsMassachusetts General HospitalBostonUSA

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