Emergency Medicine

284 Orthopaedic Emergencies

INJURIES TO THE ELBOW AND FOREARM

Condylar and epicondylar fractures of the humerus

DIAGNOSIS

1 The lateral condyle is usually fractured in children, and the medial

epicondyle at any age, due to direct violence or forced contraction of the

forearm f lexors that attach to it.

2 There is pain, swelling (which may be minimal) and loss of full elbow exten-

sion if the medial epicondyle is trapped in the joint, usually following dis-

location of the elbow.

3 Test for ulnar nerve damage, causing sensory loss over the medial one-and-

a-half digits and weakness of the finger adductors and abductors.

4 X-rays are often difficult to interpret in children, as many of the structures

are still cartilaginous. Helpful clues to look for are:

(i) The posterior fat-pad sign (see Fig. 9.1). This indicates a joint

effusion, and is indirect evidence of significant trauma. It is also

typically seen with radial head fractures.

(ii) Comparison with the normal elbow placed in a similar

anatomical position. Look for any differences between the two

sides.

(iii) Suspect displacement from injury if an epiphysis that should be

visible by age is missing

Figure 9.1 Line-drawing of a lateral elbow X-ray showing an anterior and posterior
fat-pad sign (shaded areas are abnormal and indicate a joint effusion)