Fractures around child's elbow-Radiological patterns

Background: This was a one-year prospective study aimed at evaluating the clinical and radiological patterns of the paediatric elbow fractures and determining the magnitude of the problem. The clinical and radiological pitfalls in managing such fractures were also studied and addressed. The setting was in Addis Ababa University, Medical Faculty, Department of Radiology, Tikur-Anbessa Referral/teaching Hospital.
Methods: This was a prospective study of paediatric elbow fractures that were seen at our University Hospital from January 2005 to January 2006. The study population consisted of all children aged less than 16 years who sustained trauma and had a fracture around their elbow. After thorough history and clinical examination routine PA & Lateral plain radiographs were taken. Both Orthopedic Surgeons and Radiologists discussed the findings and these were recorded using the prepared format. More X-ray views, contra lateral elbow X-rays and discussions were conducted on doubtful cases. A total of 223 elbows with fracture were followed up, 72 children with elbow trauma but without fractures were excluded from the study.
Results: Males accounted for 168 (75.5 %) of cases. A total of 214 (96%) of the injuries resulted from falls. Only in 7 children reported having been 'Hit by car' as cause of fracture and all these were males. The left side was involved in 147 (66%) of instances. The commonest fracture type was supracondylar in 154/223 (69.1%), followed by Capitallar in 31 (13.9%) and medial Epicondylar fracture in 11 (5%). Posterior displacement was the commonest direction of displacement for supracondylar fractures (44.8%). There were no radial neck and isolated medial humeral condyle fractures encountered. Trochlear fracture was of higher incidence than comparable studies. Posterior fat pad radiological sign was present in 77% of elbows. Two children were found evidently abused. Diagnosis of fracture pattern was difficult/ 'disputable' in 22 elbows and in four elbows diagnosis was completely missed and later on detected at follow-up clinics.
Conclusion: Fractured pediatric elbow is a common clinical encounter and poses a significant diagnostic challenge. Such fractures should be handled cautiously and in doubtful cases discussions between surgeon and radiologist is valuable. Posterior fat pad sign is a reliable radiological diagnostic indicator of pediatric elbow fractures. Additional diagnostic modalities like MRI should be taken to clearly visualize doubtful fractures and cartilaginous secondary new ossification centers at specific ages.