title: Predisposing Effect of Elbow Alignment on the Elbow Fracture Type in Children.
abstract: OBJECTIVE
  Under the hypothesis that the elbow alignment, namely the carrying angle, could predispose individuals to a specific type of pediatric elbow fracture after a fall onto an outstretched arm, we investigated the relationship between radiographic carrying angle and elbow fracture type in children.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  Level I pediatric trauma center.
  
  
  METHODS
  We reviewed 374 children who were diagnosed with supracondylar fracture (SCF, n = 208), lateral condylar fracture (LCF, n = 132), and radial neck fracture (RNF, n = 34).
  
  
  METHODS
  The association between the radiographic carrying angle and the fracture type was investigated.
  
  
  METHODS
  To adjust for bias, 2 statistical methods were used: multivariate analysis using a baseline-category logistic model and a case-matching method using propensity score analysis.
  
  
  RESULTS
  In the multivariate analysis, with SCF patients set as the baseline category, a more valgus-deviated elbow (increased carrying angle, P = 0.011) predisposed individuals to RNF, whereas a more varus-deviated elbow (decreased carrying angle, P < 0.001) predisposed them to LCF. In the case-matched analysis, there were also significant differences in carrying angles between RNF and case-matched SCF patients (14.3 vs. 11.4 degrees, P = 0.013) and between LCF and case-matched SCF patients (7.7 vs. 11.7 degrees, P < 0.001).
  
  
  CONCLUSIONS
  Elbow alignment, which may influence the transmission of traumatic force during a fall onto an outstretched elbow, could be a predisposing factor for specific types of pediatric elbow fracture. The results provide the additional information about the injury mechanisms of pediatric elbow fracture and may deepen our understanding of the fractures.
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Seungcheol
authors.initials: S
authors.lastname: Kang
authors.forename: Soo-Sung
authors.initials: SS
authors.lastname: Park
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D000092464:Elbow Injuries