Learning objectives
This manuscript aims to describe the most common pitfalls in the diagnosis of pediatric elbow fractures and to provide a practical guide for a radiologist to avoid misdiagnosis in the daily work routine.
Background
Pediatric elbow fractures constitute up to 15% of all pediatric fractures [1]. According to a study of Emery K. H. et al. the three most common pediatric elbow fractures include supracondylar (56%), radial neck (17%), and lateral condylar (15%) fractures [2].
Most traumatic elbow injuries associate with both hyperextension/rotation movements and valgus/varus stress forces applied to the elbow joint. Less often they could be caused by direct impact forces [3].
After trauma children admitted to the emergency department (ED) are usually addressed to perform further...
Findings and procedure details
Through a search in our RIS-PACS database we selected all the post-trauma elbow traditional radiographs requested by the ED from 1st January 2021 to 31st June 2021 for patients under the age of 18. We found a total of 55 pediatric patients. It was decided to narrow the pool of study by choosing only the patients who underwent a second radiological examination (usually required within 24 hours) and/or those who were treated by orthopedics (with a plaster cast or surgically) despite a first radiologic report...
Conclusion
Only 1 among all the 7 patient who were double evaluated by radiographs had a missed fracture at the follow-up radiography. The other 6 patients were all correctly reported for fracture at the second exam, which was usually required after a first technically incorrect radiographs acquisition.
The mechanisms of elbow trauma are complex, and the resulting fractures are often subtle. Being aware of the injury mechanism and of the simple tips described helps the radiologist in the x-ray evaluation. This study further suggests that it...
Personal information and conflict of interest
e. tallamona:
Nothing to disclose
G. Belfiore:
Nothing to disclose
A. Di Mari:
Nothing to disclose
S. Cusumano:
Nothing to disclose
t. vasile:
Nothing to disclose
R. Farina:
Nothing to disclose
I. Pennisi:
Nothing to disclose
S. Palmucci:
Nothing to disclose
A. Basile:
Nothing to disclose
References
Azizkhani, R., Hosseini Yazdi, Z. & Heydari, F. Diagnostic accuracy of ultrasonography for diagnosis of elbow fractures in children.Eur J Trauma Emerg Surg(2021).
Eckert, K., Ackermann, O., Janssen, N.et al.Accuracy of the sonographic fat pad sign for primary screening of pediatric elbow fractures: a preliminary study.J Med Ultrasonics41,473–480 (2014).
Vito Pavone, Ludovico Lucenti, Pasquale Farsetti. Le fratture della paletta omerale nei bambini. Lo Scalpello (2018) 32:246-251.
Eren, M.B., Aşçı, M., Bilgiç, E.et al.A Practical Method for Obtaining True Lateral Elbow X-rays in a Paediatric Age...