A 14-Year-Old Boy with Elbow Pain After a Fall on an Outstretched Hand

Differential Diagnosis

• Elbow dislocation
• Fat pad sign
• Lateral condyle fracture
• Osteolytic lesion
• Radial head fracture

Diagnosis

This patient experienced a fracture of the lateral humeral condyle. Subtle curvilinear lucency is seen at the distal margin of the lateral humeral condyle. Capitellum appears normal, and no joint effusion is apparent.

 

Learnings/What to Look for

• Pediatric condyle fracture is relatively common, accounting for 20% of elbow fractures
• Findings can be subtle
• The mechanism is often a fall on an outstretched hand, typically with the forearm in abduction and the elbow in extension
• Injuries may also involve the brachial artery and the ulnar nerve

 

Pearls for Urgent Care Management and Consideration for Transfer

• Initial management involves adequate analgesia and immobilization
• Fractures of the lateral condyle of humerus are unstable even when immobilized; these fractures are also prone to nonunion since the fracture is intraarticular and is bathed in synovial fluid
• The arm should be placed in a sling and swathed for comfort; the patient should be referred to an orthopedic surgeon for follow-up
• Indications for transfer include:
  • Open fractures
  • Concerning mechanism of injury, such as major trauma from a motor vehicle collision
  • Vascular or nerve injury
  • Unstable vital signs