Radiographic Evaluation of the Pediatric Elbow

Abstract

Pediatric elbow fractures are difficult clinical challenges to manage for many reasons. For the inexperienced surgeon, however, interpretation of x-rays of the injured child’s elbow is perhaps the most daunting of tasks. The elbow is a complex joint with three articulations that allow flexion-extension of the elbow joint as well as pronation-supination of the forearm. The developmental bony anatomy is also complex, as ossification centers form sequentially over time. Starting out as cartilaginous anlagen, the distal humerus, proximal radius, and proximal ulna progress through skeletal maturity via a predictable pattern of ossification. These sequential bony changes make the radiographic appearance of the pediatric elbow appear differently year to year, making x-ray interpretation complicated and fraught with errors of both under- and overdiagnosis of injuries. Mastery of the radiographic assessment of the pediatric elbow is critical to success of care of pediatric elbow trauma and an important goal for the young surgeon.