1. Common Pediatric Elbow Injuries

• Supracondylar fracture of humerus (most common)
• Lateral condyle fracture of humerus
• Medial epicondyle fracture
• Elbow dislocation
• Radial neck fracture
• Olecranon fracture

---

2. Supracondylar Fracture

---

Mechanism

• Fall on outstretched hand
• Hyperextension injury
• Distal fragment displaced posteriorly

---

Classification (Gartland)

• Type I: Undisplaced
• Type II: Displaced with intact posterior cortex
• Type III: Completely displaced

---

Complications

• Neurovascular injury
  • Brachial artery
  • Median nerve (anterior interosseous nerve)
• Compartment syndrome leading to Volkmann ischemic contracture
• Malunion
  • Cubitus varus deformity (gunstock deformity)
• Hyperextension deformity

---

Management

• Emergency referral
• Closed reduction with percutaneous pinning
• Lateral pin configuration preferred
• Immobilization after fixation

---

3. Elbow Dislocation

---

Key Points

• Usually posterior dislocation
• Frequently associated with medial epicondyle fracture

---

Important Rule

• Always obtain post-reduction radiographs
• Hidden fractures may only become evident after reduction

---

Management

• Closed reduction
• Surgical fixation if associated fracture is present

---

4. Medial Epicondyle Fracture

---

Anatomy

• Origin of flexor–pronator muscle group
• Ulnar collateral ligament attaches distal to the epicondyle

---

Mechanism

• Valgus stress
• Avulsion injury

---

Clinical Importance

• Commonly associated with elbow dislocation
• Fragment may become incarcerated within the joint

---

Treatment

• Often conservative

---

Indications for Surgery

• Significant displacement
• Fragment trapped inside joint
• High-demand athlete (throwing arm)

---

5. Ulnar Collateral Ligament Injury

---

Mechanism

• Repetitive valgus stress in throwing athletes

---

Risk Factors

• Excessive pitching duration
• High pitch counts
• High velocity throwing
• Fatigue

---

Clinical Features

• Medial elbow pain
• Instability

---

Management

• Rest in early stages
• Reconstruction in severe cases

---

6. Little Leaguer’s Elbow

---

Definition

• Medial epicondyle apophysitis

---

Features

• Pain in young throwing athletes
• Widening or fragmentation of apophysis
• Enlargement of dominant side

---

Treatment

• Rest from throwing
• Gradual return to activity

---

7. Osteochondritis Dissecans of Capitellum

---

Mechanism

• Repetitive lateral compartment compression

---

Features

• Pain with loss of extension
• Mechanical symptoms such as locking

---

Imaging

• X-ray shows irregular capitellum
• MRI identifies unstable fragments

---

Treatment

• Early stage: rest
• Advanced stage: arthroscopic debridement with or without microfracture

---

8. Olecranon Injuries

---

Types

• Olecranon fracture
• Olecranon apophysitis

---

Mechanism

• Repetitive traction from triceps
• Common in throwers and gymnasts

---

Treatment

• Rest
• Surgical fixation if indicated

---

9. Biomechanics of the Elbow

---

Forces During Throwing

• Lateral compartment: compression
  • Associated with osteochondritis dissecans
• Medial compartment: tension
  • Associated with ulnar collateral ligament injury
  • Medial epicondyle avulsion

---

10. Differential Diagnosis by Compartment

---

Medial

• Medial epicondyle fracture
• Ulnar collateral ligament injury
• Ulnar nerve instability
• Little leaguer’s elbow

---

Lateral

• Osteochondritis dissecans
• Radial head pathology
• Loose bodies

---

Posterior

• Olecranon fracture
• Olecranon apophysitis
• Triceps injury

---

Anterior

• Capsular injury
• Loose bodies

---

11. Key Exam Pearls

---

• Most common pediatric elbow fracture: supracondylar fracture
• Most serious complication: Volkmann ischemic contracture
• Always assess pulses and nerve function
• Always obtain post-reduction imaging in elbow dislocation
• Medial elbow pain in throwers suggests UCL injury or apophysitis
• Loss of extension suggests osteochondritis dissecans
• Cubitus varus results from malunion and is mainly cosmetic

---

12. Prevention

---

• Limit pitch counts
• Avoid year-round pitching
• Encourage participation in multiple sports
• Early evaluation of elbow pain

---

Final Takeaway

• Pediatric elbow injuries require:
  • Careful neurovascular assessment
  • Knowledge of growth plate anatomy
  • Awareness of sport-related overuse injuries
• Early recognition prevents:
  • Deformity
  • Instability
  • Long-term dysfunction

Courtesy: Mary Lloyd Ireland M.D. Associate Professor University of Ketucky Lexington, KY, USA www.MaryLloydIreland.com http://orthopaedics.med.uky.edu/