title: Fishtail deformity--a delayed complication of distal humeral fractures in children.
abstract: BACKGROUND
  Concavity in the central portion of the distal humerus is referred to as fishtail deformity. This entity is a rare complication of distal humeral fractures in children.
  
  
  OBJECTIVE
  The purpose of this study is to describe imaging features of post-traumatic fishtail deformity and discuss the pathophysiology.
  
  
  METHODS
  We conducted a retrospective analysis of seven cases of fishtail deformity after distal humeral fractures.
  
  
  RESULTS
  Seven children ages 7-14 years (five boys, two girls) presented with elbow pain and history of distal humeral fracture. Four of the seven children had limited range of motion. Five children had prior grade 3 supracondylar fracture treated with closed reduction and percutaneous pinning. One child had a medial condylar fracture and another had a lateral condylar fracture; both had been treated with conservative casting. All children had radiographs, five had CT and three had MRI. All children had a concave central defect in the distal humerus. Other imaging features included joint space narrowing with osteophytes and subchondral cystic changes in four children, synovitis in one, hypertrophy or subluxation of the radial head in three and proximal migration of the ulna in two.
  
  
  CONCLUSIONS
  Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment.
authors.affiliation: Department of Radiology, Division of Pediatric Imaging, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
authors.forename: Srikala
authors.initials: S
authors.lastname: Narayanan
authors.forename: Randheer
authors.initials: R
authors.lastname: Shailam
authors.forename: Brian E
authors.initials: BE
authors.lastname: Grottkau
authors.forename: Katherine
authors.initials: K
authors.lastname: Nimkin
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000150:complications* / Q000175:diagnosis; D006811:Humerus / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D008297:Male; D010020:Osteonecrosis / Q000175:diagnosis* / Q000209:etiology*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed