Have you ever been working a shift at 3 am and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This can be a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify common and catastrophic injuries. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. We reviewed the approach to the pediatric elbow previously. Now, the “Can’t Miss” pediatric elbow injuries.
The Pediatric Elbow
- 10% of all pediatric fractures involve the elbow .
- Missed injuries can cause significant deformity, pain, or functional/neurologic complications .
- With many ossification centers, subtle injuries, and significant consequences, the pediatric elbow x-ray can be challenging but important to interpret.
- Non-accidental trauma is, unfortunately, a not uncommon reality. Have a high suspicion for it, especially when there are inconsistencies in the story, mechanism, or the child’s developmental stage. There are certain highly suspicious fracture patterns to be aware of that will be highlighted when appropriate.
- DeFroda SF, Hansen H, Gil JA, Hawari AH, Cruz AI Jr. Radiographic Evaluation of Common Pediatric Elbow Injuries. Orthop Rev (Pavia). 2017;9(1):7030. Published 2017 Feb 20. PMID: 28286625
- Boutis K. Pediatric Orthopedic Emergencies. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill; Accessed December 23, 2020. https://accessmedicine.mhmedical.com/content.aspx?bookid=2353§ionid=220291079
- Allen SR, Hang JR, Hau RC. Review article: paediatric supracondylar humeral fractures: emergency assessment and management. Emerg Med Australas. 2010;22(5):418-426. PMID: 20874821
- Tejwani N, Phillips D, Goldstein RY. Management of lateral humeral condylar fracture in children. J Am Acad Orthop Surg. 2011;19(6):350-358. PMID: 21628646
- Beck JJ, Bowen RE, Silva M. What’s New in Pediatric Medial Epicondyle Fractures?. J Pediatr Orthop. 2018;38(4):e202-e206. PMID: 27861213
- Imani G, Graber M. Radial Head Dislocation. 2020 Sep 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 31335090
- Chow YC, Lee SW. Elbow and Forearm Injuries. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill; Accessed December 23, 2020. https://accessmedicine.mhmedical.com/content.aspx?bookid=2353§ionid=222324767
- Pring ME. Pediatric radial neck fractures: when and how to fix. J Pediatr Orthop. 2012;32 Suppl 1:S14-S21. PMID: 22588098
- Holme TJ, Karbowiak M, Arnander M, Gelfer Y. Paediatric olecranon fractures: a systematic review. EFORT Open Rev. 2020;5(5):280-288. Published 2020 May 1. PMID: 32509333
- Kuhn MA, Ross G. Acute elbow dislocations. Orthop Clin North Am. 2008;39(2):155-v. PMID: 1837480
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