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Resolution

There is a suspicious line on the front view; the angle of the distal humerus (on lateral) is also suspicious.
As initially suspected, this child sustained a supracondylar fracture of the distal humerus and was placed in a cast splint at 90° at the elbow. 

It should be noted that such fractures are ripe for complication, due in part to the fact that they can be easy to miss. Vigilance based on mechanism of injury is advised.

Acknowledgment: Case presented by Nahum Kovalski, BSc, MDCM, Terem Emergency Medical Centers, Jerusalem, Israel. 

These cases are among hundreds that can be found in Terem’s online X-ray Teaching File, with more being added

Clinical Challenge: February, 2011

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services