Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

Overview

Pediatric elbow fractures broadly include:

1. Supracondylar fractures of the humerus
2. Fractures involving ossification centres

This section focuses on fractures involving ossification centres.

---

Ossification Centres of the Elbow

Understanding timing is critical for diagnosis.

Elbow ossification centers CRITOE

---

1. Transepiphyseal Separation of Distal Humerus

---

Key Clinical Points

• Seen in very young children, often below 1 year
• Strongly consider non-accidental injury

---

Differentiation from Elbow Dislocation

---

Key Diagnostic Point

• If the radiocapitellar line is intact and radial head aligns with capitellum, diagnosis favors transepiphyseal separation

---

Clinical Importance

• Often missed
• High suspicion required in infants with elbow injury

---

2. Lateral Condylar Fracture of Humerus

---

Classification

• Typically Salter-Harris classification Type IV

---

Key Points

• Appears nondisplaced on standard views
• Internal rotation view may reveal displacement

---

Management

• Requires close follow-up if treated conservatively
• Most cases are displaced and require surgery

---

Surgical Principle

• Use lateral approach
• Avoid posterior approach
  • Risk of avascular necrosis of capitellum

---

Complications

1. Non-union

• Leads to cubitus valgus deformity

2. Ulnar Nerve Symptoms

• Develop over time due to stretch from valgus deformity

---

Treatment of Complications

• Non-union with pain: bone grafting and fixation
• Ulnar nerve symptoms: decompression or transposition

---

Key Exam Point

• Lateral condylar fracture is considered a surgical fracture

---

3. Medial Epicondyle Fracture

---

Key Points

• Last ossification centre to fuse
• Commonly associated with elbow dislocation

---

Management

• Usually treated conservatively

---

Indications for Surgery

• Displacement greater than 1 cm (controversial)
• Fragment trapped within the joint

---

Important Step

• Always check for medial epicondyle on post-reduction X-ray

---

4. Radial Head and Neck Fractures

---

Management Criteria

• Less than 30 degrees angulation: conservative treatment

---

If Displacement is Greater Than 30 Degrees

• Closed reduction

---

If Reduction is Difficult

• Percutaneous pin used as joystick

---

Indication for Open Reduction

• Residual angulation greater than 45 degrees

---

Complications

1. Synostosis

• Fusion between radius and ulna
• May be due to periosteal interposition

---

2. Osteonecrosis

• Due to disruption of blood supply

---

3. Loss of Motion

• Common complication

---

4. Non-union (Rare)

• May be due to periosteal interposition

---

5. Compartment Syndrome

• Must be actively monitored

---

Key Radiological Rule

• Radiocapitellar line must pass through the capitellum in all views

---

High-Yield Exam Pearls

• Elbow dislocation is rare in infants, suspect transepiphyseal separation
• Lateral condylar fracture has high risk of non-union and deformity
• Medial epicondyle fragment may be trapped inside the joint
• Radial head fractures should avoid open reduction when possible
• Always correlate age with ossification centres
• Always assess radiocapitellar alignment

---

Final Takeaway

• Pediatric elbow injuries require:
  • Knowledge of ossification sequence
  • Careful radiographic interpretation
  • High suspicion for subtle injuries
• Missing these injuries can lead to:
  • Deformity
  • Nerve complications
  • Long-term functional impairment