Radial head fracture (peds)
This page is for pediatric patients. For adult patients, see: radial head fracture
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
- 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
- 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
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Ortho consultation to guide treatment
- ORIF indicated when angulation >60 degrees or displacement >50%
Disposition
- Consult ortho