title: Pediatric elbow fractures: a new angle on an old topic.
abstract: BACKGROUND
  The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50-70%), lateral condylar (17-34%), and medial epicondylar fractures (10%), with fractures of the proximal radius (including but not limited to fractures of the radial neck) being relatively uncommon (5-10%). Our experience at a large children's hospital suggests a different distribution.
  
  
  OBJECTIVE
  Our goals were (1) to ascertain the frequency of different elbow fracture types in a large pediatric population, and (2) to determine which fracture types were occult on initial radiographs but detected on follow-up.
  
  
  METHODS
  Review of medical records identified 462 children, median age 6 years and interquartile range for age of 4-8 years (range 0.8-18 years), who were diagnosed with elbow fractures at our institution over a 10-month period. Initial and follow-up radiographs were reviewed in blinded fashion independently by two experienced pediatric musculoskeletal radiologists to identify fracture types on initial and follow-up radiographs.
  
  
  RESULTS
  The most common fractures included supracondylar (n = 258, 56%), radial neck (n = 80, 17%), and lateral condylar (n = 69, 15%). Additional fractures were seen on follow-up exams in 32 children. Of these, 25 had a different fracture type than was identified on initial radiographs. The most common follow-up fractures were olecranon (n = 23, 72%), coronoid process (n = 4, 13%) and supracondylar (n = 3, 9%). Olecranon fractures were significantly more common on follow-up radiographs than they were on initial radiographs (n = 33, 7%; P < .0001). Twenty-six children had more than one fracture type on the initial radiograph. The most common fracture combinations were radial neck with olecranon (n = 9) and supracondylar with lateral condylar (n = 9).
  
  
  CONCLUSIONS
  Supracondylar fractures are the most frequent elbow fracture seen initially, followed by radial neck, lateral condylar, and olecranon fractures in a distribution different from what has been historically described. The relatively high frequency of olecranon fractures detected on follow-up speaks to their potentially occult nature. Careful attention to these areas is warranted in children with initially normal radiographs.
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. kathleen.emery@cchmc.org.
authors.forename: Kathleen H
authors.initials: KH
authors.lastname: Emery
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Zingula
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Anton
authors.affiliation: Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Shelia R
authors.initials: SR
authors.lastname: Salisbury
authors.affiliation: Department of Pediatric Orthopedics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Junichi
authors.initials: J
authors.lastname: Tamai
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004551:Elbow Joint / Q000000981:diagnostic imaging*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D015588:Observer Variation; D009820:Ohio / Q000453:epidemiology; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012307:Risk Factors; D016037:Single-Blind Method; D014458:Ulna Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D000092464:Elbow Injuries
keywords: Children; Elbow; Fracture; Radiography