Case: A previously healthy 6 year old male presents with left elbow pain after wrestling with a friend. What is the diagnosis? Click on image for a larger view.
Poll Results
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Type II Supracondylar fracture of the elbow
Explanation
More than half of all pediatric elbow fractures are supracondylar, because this is the weakest part of the elbow joint. They are most commonly caused by a fall on outstretched hand.1
In this case, the anterior humeral line (red) does not intersect the middle third of the capitellum, suggesting a fracture. The arrow points to a disruption of the anterior cortex.
Choice of treatment is guided by the Gartland classification. Most orthopedists recommend conservative management for non or minimally displaced fractures, while displaced fractures are treated with operative fixation.2
Gartland classification2
| Type | Extent of injury | Radiographic finding | Treatment |
| I | Non-displaced, subtle | Intact anterior humeral line (may only have posterior fat pad) | Splint, non-operative |
| II | Displaced, posterior cortex intact | Anterior humeral line not through middle 1/3 of capitellum | Likely operative |
| III/IV | Completely displaced | Rotation, comminution | Operative |
Special attention must be paid to a careful neurovascular exam to evaluate for compartment syndrome. A delay in diagnosis can lead to the devastating complication of Volkmann’s ischemic contracture, which results in severe muscle fibrosis and neuropathy.3
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Master Clinician Bedside Pearls
Christopher I. Doty, MD
Program Director & Vice Chair for Education
Associate Professor of Emergency Medicine
University of Kentucky-Chandler Medical Center
Author information
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