Pediatric elbow fractures: a new angle on an old topic

• Published in: Pediatric radiology 2016, Vol.46 (1), p.61-66
• Main Authors: Emery, Kathleen H., Zingula, Shannon N., Anton, Christopher G., Salisbury, Shelia R., Tamai, Junichi
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Comorbidity; Elbow Joint - diagnostic imaging; Elbow Joint - injuries; Humans; Imaging; Incidence; Infant; Male; Medicine; Medicine & Public Health; Neuroradiology; Nuclear Medicine; Observer Variation; Ohio - epidemiology; Oncology; Original Article; Pediatrics; Radiography; Radiology; Radius Fractures - diagnostic imaging; Radius Fractures - epidemiology; Risk Factors; Single-Blind Method; Ulna Fractures - diagnostic imaging; Ulna Fractures - epidemiology; Ultrasound
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-015-3439-0

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