Paediatric Elbow Injuries

Paediatric elbow injuries are common, and the immature elbow, with its ossification centres and open physes, changes both the injury patterns and how radiographs are read.

This page covers the 3 that dominate:

• •Supracondylar humeral fracture: the commonest paediatric elbow fracture, with the greatest neurovascular risk
• •Medial epicondyle avulsion: an adolescent apophyseal injury, often with elbow dislocation or throwing
• •Pulled elbow: radial head subluxation through the annular ligament in a young child

Also keep in mind lateral condyle fracture (the second commonest, often subtle and a recognised miss), radial neck and olecranon fractures, elbow dislocation and Monteggia injury. Consider non-accidental injury throughout.

The growing elbow has 6 secondary ossification centres that appear in a predictable order, CRITOE: Capitellum, Radial head, Internal (medial) epicondyle, Trochlea, Olecranon, External (lateral) epicondyle. The sequence prevents 2 classic errors: calling a normal centre a fracture, and missing an avulsed medial epicondyle trapped in the joint.

Mechanisms:

• •Supracondylar fracture: a fall on the outstretched hand with the elbow extended. About 95% are extension-type, with the distal fragment displaced posteriorly; the brachial artery and the median and anterior interosseous nerves lie close by
• •Medial epicondyle avulsion: valgus or traction force, classically with an elbow dislocation in adolescents, or repetitive valgus stress in throwers. The ulnar nerve runs just behind the epicondyle
• •Pulled elbow: sudden traction on a pronated, extended forearm lets the annular ligament slip over the radial head, typically at 1 to 4 years