Radial head fracture (peds)

This page is for pediatric patients; see radial head fracture for adult patients.

Background

• Radial neck fractures tend to be more common in the pediatric population than radial head fractures
• Majority are Salter II fractures
• Average age is approximately 10 yrs

Clinical Features

• Mechanism is typically FOOSH
• Tenderness over the elbow
• May include posterior interosseous nerve intrapment causing a finger drop

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

• Distal humerus fracture
• Radial head fracture
  • Essex-Lopresti fracture
• Capitellum fracture
• Olecranon fracture
• Elbow dislocation

Radiograph-Negative

• Biceps tendon rupture/dislocation
• Lateral epicondylitis
• Medial epicondylitis
• Olecranon bursitis (nonseptic)
• Pronator teres syndrome
• Septic bursitis

Pediatric

• Nursemaid's elbow
• Supracondylar fracture
• Lateral epicondyle fracture
• Medial epicondyle fracture
• Olecranon fracture
• Radial head fracture
• Salter-Harris fractures

Evaluation

Workup

Radial head fracture (red arrow) with posterior and anterior sail sign (blue arrows).

• AP and lateral elbow xray
  • Assess for anterior fat pad

Diagnosis

Knowledge of ossification centers of the elbow can be helpful (see Elbow X-ray)

Elbow Ossification by Age (CRITOE)

Ossification Center	Age of Appearance (add 1yr for boys)	Age at Fusion
Capitellum	1yr	12-14 yrs
Radial head	3yr	14-16 yrs
Internal epicondyle	5yr	16-18 yrs
Trochlea	7yr	12-14 yrs
Olecranon	9yr	15-17 yrs
External epicondyle	11yr	12-14 yrs

Management

• Ortho consultation to guide treatment
• ORIF indicated when angulation >60 degrees or displacement >50%

Disposition

• Consult ortho

See Also

• Elbow diagnoses
• Radial head fracture (Adult)