![]() ![]() Flexion type injuries are far less common, accounting for 1–3%, and open fractures are also rare, occurring in approximately 1% and more frequently in the older child. And falls from play equipment are frequently implicated. There is a higher incidence of injury over weekends and during the summer months. This produces an extension type fracture, which accounts for 97–99% of injuries and may be influenced by the ligamentous laxity that is common in this age group, predisposing to elbow hyper-extension. The mechanism of injury is usually a fall onto an outstretched hand, with axial transmission of body weight through the maximally extended elbow. This injury is reported to be more common in males but there is a lack of consensus, some reports indicating a higher incidence in females and a recent evaluation of a cohort of > 63,000 children over a five year period did not demonstrate a statistically significant difference. ![]() The median age of presentation is six years, and the incidence gradually reduces with age until age 15, when patients tend to present with an adult pattern. For now, continue to splint patients for whom you have high suspicion of an occult fracture.Supracondylar fractures of the distal humerus account for approximately 15% of all paediatric fractures. Although not ready for prime time yet, this is an interesting technique that may result in decreased painful immobilization and improved overall morbidity.Next time you encounter a pediatric elbow injury with negative x-rays in the ED, grab an ultrasound probe to evaluate for a fat pad sign and lipohemarthrosis.Elbow ultrasound can assist in ruling out a supracondylar fracture, which is particularly helpful in the case of an equivocal x-ray but high clinical suspicion.6 The test characteristics for ultrasound in demonstrating lipohemarthrosis are as follows: 5The ultrasound demonstrated either an elevated posterior fat pad or lipohemarthrosis with the following test characteristics:ġ4 patients with x-rays showing elbow joint effusion but no fracture who underwent ultrasound and MRI. Before obtaining radiographs, pediatric emergency physicians performed an ultrasound. 33% patients had a radiograph result positive for fracture. Study 3: Annals of Emergency Medicine 2013ġ30 pediatric patients with elbow injuries. Lipohemarthrosis sensitivity 92% (11 cases).Posterior fat pad sign sensitivity 100% (13 cases).Of the 21 cases who had normal ultrasounds, none were later diagnosed with a fracture.13 of the 34 cases had identified an occult fracture.Patients were splinted until they had an ultrasound performed within 6 days of the injury. Patients with bone deformity diagnosed on initial radiographs were excluded. Study 2: Orthopaedics & Traumatology: Surgery & Research 2016Ī French study of 34 cases of pediatric elbow trauma with suspected occult fracture. The test characteristics were as follows: 4 Elbow Ultrasound vs Radiograph Study 1: European Journal of Trauma and Emergency Surgery 2014Ī German study investigated ultrasound accuracy (identifying cortical deformity or a posterior fat pad) compared to standard radiographs in diagnosing supracondylar fractures in 106 pediatric patients. ![]()
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