After working this past week, I have a new found love/disdain for upper extremity fractures in kids – not sure how 5 kids coordinated their injuries to all arrive at the same time… but it gives me hope for our future generations.
oThe x-ray of the elbow often causes palpitations in us/me. Looking at all of those radiolucent areas can be confusing.
o Recall: CRITOE – the order of the APPEARANCE of the elbow’s ossification centers
Capitellum (F – 1yo / M – 2yo)
Radial Head (F – 3yo / M – 4yo)
Internal (medial) Epicondyle (F – 5yo / M – 6yo)
Trochlea (F – 7yo / M – 8yo)
Olecranon (F – 9yo/ M – 10yo)
External (lateral) Epicondyle (F – 11yo M – 12yo)
o Lateral Epicondyle Fractures are the 2nd most common elbow fracture (10-20%)
o Mechanism = Fall on outstretched hand with arm abducted and elbow extended
o When compared to Supracondylar Fxs, there is often more Lateral Ecchymosis
o The fracture line may not appear until 7-10 days after injury (trust your exam… splint liberally).
o It may be difficult to diagnose and will often appear as a Salter-Harris II fracture, but in fact, the majority will be Salter-Harris IV and are highly unstable.
o Management: only truly non-displaced fractures can be managed non-operatively.
Non-displaced fractures – minimal lateral soft tissue swelling
Significant soft tissue swelling likely indicates unstable fracture.
Casted fractures that appeared non-displaced may become displaced so close follow-up is needed.
Most will require operative pinning.
o Complications – Non-union with growth arrest, avascular necrosis, valgus/varus deformity, Ulnar nerve palsy (although not acutely – the risk of neurovascular compromise is much lower than supracondylar fractures).
Wheeless, CR. Frx of the lateral condyle in children in Wheeless’ Textbook of Orthopaedics. Online: http://www.wheelessonline.com/ortho/frx_of_the_lateral_condyle_in_children
Sarraff, LM. and Haines, CJ. Common Orthopedic Injuries in the Pediatric ED. Pediatric Emergency Medicine Reports. 2010; 15: 77-91.