Skip to main content

Pediatric elbow fractures: a new angle on an old topic

Abstract

Background

The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50–70%), lateral condylar (17–34%), and medial epicondylar fractures (10%), with fractures of the proximal radius (including but not limited to fractures of the radial neck) being relatively uncommon (5–10%). Our experience at a large children’s hospital suggests a different distribution.

Objective

Our goals were (1) to ascertain the frequency of different elbow fracture types in a large pediatric population, and (2) to determine which fracture types were occult on initial radiographs but detected on follow-up.

Materials and methods

Review of medical records identified 462 children, median age 6 years and interquartile range for age of 4–8 years (range 0.8–18 years), who were diagnosed with elbow fractures at our institution over a 10-month period. Initial and follow-up radiographs were reviewed in blinded fashion independently by two experienced pediatric musculoskeletal radiologists to identify fracture types on initial and follow-up radiographs.

Results

The most common fractures included supracondylar (n = 258, 56%), radial neck (n = 80, 17%), and lateral condylar (n = 69, 15%). Additional fractures were seen on follow-up exams in 32 children. Of these, 25 had a different fracture type than was identified on initial radiographs. The most common follow-up fractures were olecranon (n = 23, 72%), coronoid process (n = 4, 13%) and supracondylar (n = 3, 9%). Olecranon fractures were significantly more common on follow-up radiographs than they were on initial radiographs (n = 33, 7%; P < .0001). Twenty-six children had more than one fracture type on the initial radiograph. The most common fracture combinations were radial neck with olecranon (n = 9) and supracondylar with lateral condylar (n = 9).

Conclusion

Supracondylar fractures are the most frequent elbow fracture seen initially, followed by radial neck, lateral condylar, and olecranon fractures in a distribution different from what has been historically described. The relatively high frequency of olecranon fractures detected on follow-up speaks to their potentially occult nature. Careful attention to these areas is warranted in children with initially normal radiographs.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Landin LA (1983) Fracture patterns in children. Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950–1979. Acta Orthop Scand Suppl 202:1–109

    PubMed  CAS  Article  Google Scholar 

  2. Reed MH (1977) Fractures and dislocations of the extremities in children. J Trauma 17:351–354

    PubMed  CAS  Article  Google Scholar 

  3. Worlock P, Stower M (1986) Fracture patterns in Nottingham children. J Pediatr Orthop 6:656–660

    PubMed  CAS  Article  Google Scholar 

  4. Lichtenberg RP (1954) A study of 2,532 fractures in children. Am J Surg 87:330–338

    PubMed  CAS  Article  Google Scholar 

  5. Blount WP, Schulz I, Cassidy RH (1951) Fractures of the elbow in children. J Am Med Assoc 146:699–704

    PubMed  CAS  Article  Google Scholar 

  6. Hanlon CR, Estes WL Jr (1954) Fractures in childhood, a statistical analysis. Am J Surg 87:312–323

    PubMed  CAS  Article  Google Scholar 

  7. Landin LA, Danielsson LG (1986) Elbow fractures in children. An epidemiological analysis of 589 cases. Acta Orthop Scand 57:309–312

    PubMed  CAS  Article  Google Scholar 

  8. Maylahn DJ, Fahey JJ (1958) Fractures of the elbow in children; review of three hundred consecutive cases. J Am Med Assoc 166:220–228

    PubMed  CAS  Article  Google Scholar 

  9. Skaggs DL, Mirzayan R (1999) The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Joint Surg Am 81:1429–1433

    PubMed  CAS  Google Scholar 

  10. Donnelly LF, Klostermeier TT, Klosterman LA (1998) Traumatic elbow effusions in pediatric patients: are occult fractures the rule? AJR Am J Roentgenol 171:243–245

    PubMed  CAS  Article  Google Scholar 

  11. Silberstein MJ, Brodeur AE, Graviss ER (1982) Some vagaries of the radial head and neck. J Bone Joint Surg Am 64:1153–1157

    PubMed  CAS  Google Scholar 

  12. Ogden JA (2000) Radius and ulna. In: Ogden JA (ed) Skeletal injury in the child, 3rd edn. Springer, New York

    Google Scholar 

Download references

Conflicts of interest

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kathleen H. Emery.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Emery, K.H., Zingula, S.N., Anton, C.G. et al. Pediatric elbow fractures: a new angle on an old topic. Pediatr Radiol 46, 61–66 (2016). https://doi.org/10.1007/s00247-015-3439-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-015-3439-0

Keywords

  • Children
  • Elbow
  • Fracture
  • Radiography