Occult elbow fractures in children: some tips and tricks to read radiographs

Courvoisier A, Calvelli N, Bourgeois E, Eid A, Griffet J. Occult elbow fractures in children: some tips and tricks to read radiographs. Med Emergency, MJEM 2014; 20:30-4.

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Correspondent author: CourvoisierAURÉLIEN, MD Pediatric Orthopedic Department.Hôpital Couple-Enfant. Grenoble University Hospital Joseph Fourier University BP 217 38043 Grenoble Cedex 09 – France acourvoisier@chu-grenoble.fr
Category: Continuous Education Received: Jan. 17, 2014 Revised: Mars 13, 2014 Accepted: July 24, 2014
There is no conflict of interest to declare


Elbow traumatisms are very common in children. X-rays play important roles in the diagnosis but are sometimes difficult to read considering the quality, the normal variations of bone ossification and the type of fracture. The key to a better understanding of these fractures is first to differentiate normality from abnormality. The purpose of this report is to provide tricks and tips to help the reader when dealing with a child with an elbow traumatism. The real problem is to miss a fracture that would need a surgical treatment. Simple geometric constructions and knowledge of the aspect of the different ossification steps of a growing elbow are sufficient. But there is no need to do comparative X-Rays. This report was focused on the X-rays but one must not forget the common sense and the clinical examination to orientate the diagnosis. Finally, in cases where the X-ray is thought to be normal, a cast immobilization and evaluation 10 days after the traumatism is necessary.