An Undiagnosed Fracture of the Radial Neck in a Young Child: The Radial Neck Fleck Sign: A Case Report.

Abstract

In children, the development of the elbow involves multiple ossification centers that appear at variable stages of maturation. The unique anatomy makes radiographic evaluation of an elbow challenging in the presence of acute trauma. Understanding the developmental anatomy provides insight in terms of normal findings compared with abnormal findings on radiographs1,2. However, pediatric patients who have not undergone secondary ossification may not show the typical signs of a fracture. We report a rare case of a three-year-old boy with an undiagnosed completely displaced radial neck fracture associated with a nondisplaced olecranon fracture. The radial neck fracture was diagnosed when the follow-up radiograph showed a small, displaced ossified portion of the radial metaphysis, which we have termed the “radial neck fleck sign.” The child required closed reduction and intramedullary pinning under general anesthesia. The patient’s parent was informed that data concerning the case would be submitted for publication, and consent was provided. A three-year-old boy landed on the left elbow after jumping, and he was taken to another institution’s emergency department for evaluation and treatment. He was diagnosed with an olecranon fracture, which was treated with a long arm splint. The patient continued to have pain that was exacerbated by movement and, ten days later, presented to our orthopaedic clinic. Physical examination revealed a moderate amount of swelling at the anterior aspect of the elbow. The patient had no neurologic or vascular deficit. He refused active range of motion, but the arm was passively flexed to 90° and extended to 30°, …