Abstract
Background
Additional fractures occur in association with proximal radius fractures, but the extent of these secondary injuries has not been systematically assessed.
Objective
To ascertain the frequency and nature of additional fractures associated with proximal radius injuries in a large pediatric cohort.
Materials and methods
Radiographs meeting search criteria for proximal radius fracture during a 5-year period were reviewed. Fracture characteristics and the coexistence of additional elbow fractures were recorded and analyzed. The retrospective review was compared with initial interpretation and a blinded review by two pediatric musculoskeletal radiologists.
Results
Four hundred ninety-four proximal radius fractures were included. The radial neck was the most common fracture site (89%). Neck fractures occurred in younger patients (mean: 7.3 years) than head fractures (mean: 13.3 years) (P<0.001). Additional elbow fractures occurred in 39%, most commonly at the olecranon (22%). Additional fractures occurred in younger patients (mean: 7.2 years) than isolated proximal radius fractures (mean: 8.5 years) (P<0.001). Elbow joint effusion and complete or displaced radius fractures were each associated with additional elbow fractures (P<0.001). When compared with initial interpretation, 25% of additional fractures were not identified on initial radiographs, of which 44% were occult retrospectively. Fracture identification demonstrated excellent inter-reader reliability (interclass correlation coefficient [ICC]: 0.88, 0.94), but joint effusion interobserver agreement was only fair (ICC: 0.52, 0.41).
Conclusion
Proximal radius fractures in children often occur in association with other elbow fractures, most commonly involving the olecranon. Enhanced awareness of these fracture patterns, especially in the setting of joint effusion or complete and displaced radius fractures, may improve detection to guide appropriate management.
Similar content being viewed by others
References
Sheehan SE, Dyer GS, Sodickson AD et al (2013) Traumatic elbow injuries: what the orthopedic surgeon wants to know. Radiographics 33:869–888
Pring ME (2012) Pediatric radial neck fractures: when and how to fix. J Pediatr Orthop 32(Suppl 1):S14–S21
Emery KH, Zingula SN, Anton CG et al (2016) Pediatric elbow fractures: a new angle on an old topic. Pediatr Radiol 46:61–66
Landin LA, Danielsson LG (1986) Elbow fractures in children. An epidemiological analysis of 589 cases. Acta Orthop Scand 57:309–312
Kim HH, Gauguet JM (2018) Pediatric elbow injuries. Semin Ultrasound CT MR 39:384–396
Jacoby SM, Herman MJ, Morrison WB, Osterman AL (2007) Pediatric elbow trauma: an orthopaedic perspective on the importance of radiographic interpretation. Semin Musculoskelet Radiol 11:48–56
John SD, Wherry K, Swischuk LE, Phillips WA (1996) Improving detection of pediatric elbow fractures by understanding their mechanics. Radiographics 16:1443–1460
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
Iyer RS, Thapa MM, Khanna PC, Chew FS (2012) Pediatric bone imaging: imaging elbow trauma in children--a review of acute and chronic injuries. AJR Am J Roentgenol 198:1053–1068
Otsuka NY, Kasser JR (1997) Supracondylar fractures of the humerus in children. J Am Acad Orthop Surg 5:19–26
Kang S, Park SS (2015) Predisposing effect of elbow alignment on the elbow fracture type in children. J Orthop Trauma 29:e253–e258
Duckworth AD, Clement ND, Jenkins PJ et al (2012) The epidemiology of radial head and neck fractures. J Hand Surg Am 37:112–119
Evans MC, Graham HK (1999) Radial neck fractures in children: a management algorithm. J Pediatr Orthop B 8:93–99
Dailiana ZH, Papatheodorou LK, Michalitsis SG, Varitimidis SE (2013) Pediatric terrible triad elbow fracture dislocations: report of 2 cases. J Hand Surg Am 38:1774–1778
Falciglia F, Giordano M, Aulisa AG et al (2014) Radial neck fractures in children: results when open reduction is indicated. J Pediatr Orthop 34:756–762
Lins RE, Simovitch RW, Waters PM (1999) Pediatric elbow trauma. Orthop Clin North Am 30:119–132
Skaggs D, Pershad J (1997) Pediatric elbow trauma. Pediatr Emerg Care 13:425–434
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
Major NM, Crawford ST (2002) Elbow effusions in trauma in adults and children: is there an occult fracture? AJR Am J Roentgenol 178:413–418
Song KS, Kang CH, Min BW et al (2007) Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. J Bone Joint Surg Am 89:58–63
Gottschalk HP, Bastrom TP, Edmonds EW (2013) Reliability of internal oblique elbow radiographs for measuring displacement of medial epicondyle humerus fractures: a cadaveric study. J Pediatr Orthop 33:26–31
Griffith JF, Roebuck DJ, Cheng JC et al (2001) Acute elbow trauma in children: spectrum of injury revealed by MR imaging not apparent on radiographs. AJR Am J Roentgenol 176:53–60
Acknowledgments
This retrospective study was approved by the institutional review board of the Children’s Hospital of Philadelphia (IRB 18-015465) in accordance with 45 CFR 46.110. All presented imaging data was de-identified in accordance with HIPAA.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Degnan, A.J., Ho-Fung, V.M., Nguyen, J.C. et al. Proximal radius fractures in children: evaluation of associated elbow fractures. Pediatr Radiol 49, 1177–1184 (2019). https://doi.org/10.1007/s00247-019-04445-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-019-04445-x