Elbow anatomy and radiographic diagnosis of elbow fracture in children
- Leticia Manning Ryan, MD, MPH, FAAP
Leticia Manning Ryan, MD, MPH, FAAP
- Assistant Professor of Pediatrics
- Division of Emergency Medicine
- Johns Hopkins Children's Center
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Knowledge of anatomy, normal bony development, and radiographic features of the pediatric elbow are essential to prompt recognition and treatment of elbow injuries in children. In most instances, plain radiographs are adequate to detect fractures that pose a threat to future growth and function. On occasion, additional modalities (eg, ultrasound, magnetic resonance imaging, or arthrography) are needed to identify and fully delineate elbow fractures, especially in infants and young children.
This review discusses the anatomy, plain radiographic views, and radiographic interpretation of the pediatric elbow. Findings pertinent to specific elbow fractures in children are discussed in more detail separately. (See "Evaluation and management of supracondylar fractures in children" and "Evaluation and management of condylar elbow fractures in children" and "Epicondylar and transphyseal elbow fractures in children".)
●Ulnohumeral – Between the trochlea of the humerus and the olecranon of the ulna
●Radiohumeral – Between the capitellum of the humerus and the radial head
- Bachman D, Santora S. Orthopedic trauma. In: Textbook of Pediatric Emergency Medicine, 5th ed, Fleisher GR, Ludwig S (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1538.
- Green NE. Fractures and dislocations about the elbow. In: Skeletal Trauma in Children, 3rd ed, Green NE, Swiontkowski MF (Eds), WB Saunders, Philadelphia 2003. p.257.
- Shrader MW. Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthop Clin North Am 2008; 39:163.
- ELGENMARK O. The development of the ossific centres in some diseases in early childhood. Acta Paediatr 1948; 35:207.
- Della-Giustina K, Della-Giustina DA. Emergency department evaluation and treatment of pediatric orthopedic injuries. Emerg Med Clin North Am 1999; 17:895.
- Carson S, Woolridge DP, Colletti J, Kilgore K. Pediatric upper extremity injuries. Pediatr Clin North Am 2006; 53:41.
- Benjamin HJ, Hang BT. Common acute upper extremity injuries in sports. Clin Pediatr Emerg Med 2007; 8:15.
- Iannotti JP. Growth plate physiology and pathology. Orthop Clin North Am 1990; 21:1.
- Murray DW, Wilson-MacDonald J, Morscher E, et al. Bone growth and remodelling after fracture. J Bone Joint Surg Br 1996; 78:42.
- Price C, Phillips J, Devito D. Management of fractures. In: Lovell & Winter's Pediatric Orthopaedics, Morrissy, Weinstein SL (Eds), Lippincott Williams & Wilkins, Philadelphia 2001. p.1319.
- Campbell CC, Waters PM, Emans JB, et al. Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop 1995; 15:47.
- Baratz M, Micucci C, Sangimino M. Pediatric supracondylar humerus fractures. Hand Clin 2006; 22:69.
- Villarin LA Jr, Belk KE, Freid R. Emergency department evaluation and treatment of elbow and forearm injuries. Emerg Med Clin North Am 1999; 17:843.
- Blumberg SM, Kunkov S, Crain EF, Goldman HS. The predictive value of a normal radiographic anterior fat pad sign following elbow trauma in children. Pediatr Emerg Care 2011; 27:596.
- Donnelly LF, Klostermeier TT, Klosterman LA. Traumatic elbow effusions in pediatric patients: are occult fractures the rule? AJR Am J Roentgenol 1998; 171:243.
- Beaty JH, Kasser JR. The elbow region: General concepts in the pediatric patient. In: Rockwood and Wilkin's Fractures in Children, 5th ed, Beaty JH, Kasser JR (Eds), Lippincott Williams & Wilkins, Philadelphia 2001. p.563.
- Acton JD, McNally MA. Baumann's confusing legacy. Injury 2001; 32:41.
- Biyani A, Gupta SP, Sharma JC. Determination of medial epicondylar epiphyseal angle for supracondylar humeral fractures in children. J Pediatr Orthop 1993; 13:94.
- Davidson RS, Markowitz RI, Dormans J, Drummond DS. Ultrasonographic evaluation of the elbow in infants and young children after suspected trauma. J Bone Joint Surg Am 1994; 76:1804.
- Zuazo I, Bonnefoy O, Tauzin C, et al. Acute elbow trauma in children: role of ultrasonography. Pediatr Radiol 2008; 38:982.
- Horn BD, Herman MJ, Crisci K, et al. Fractures of the lateral humeral condyle: role of the cartilage hinge in fracture stability. J Pediatr Orthop 2002; 22:8.
- Vocke-Hell AK, Schmid A. Sonographic differentiation of stable and unstable lateral condyle fractures of the humerus in children. J Pediatr Orthop B 2001; 10:138.
- Pudas T, Hurme T, Mattila K, Svedström E. Magnetic resonance imaging in pediatric elbow fractures. Acta Radiol 2005; 46:636.
- Marzo JM, d'Amato C, Strong M, Gillespie R. Usefulness and accuracy of arthrography in management of lateral humeral condyle fractures in children. J Pediatr Orthop 1990; 10:317.
- Blane CE, Kling TF Jr, Andrews JC, et al. Arthrography in the posttraumatic elbow in children. AJR Am J Roentgenol 1984; 143:17.
- PERTINENT ANATOMY
- Elbow joint
- Ossification centers
- Growth plate (physis)
- Vascular anatomy
- Nerve anatomy
- PLAIN RADIOGRAPHIC VIEWS
- PLAIN RADIOGRAPH INTERPRETATION
- Normal ossification
- Anterior humeral line
- Radial head alignment
- Fat pads
- - Anterior fat pad
- - Posterior fat pad
- Carrying angle
- FURTHER IMAGING
- Magnetic resonance imaging
- INFORMATION FOR PATIENTS
- Interpreting elbow radiographs