Pediatric emergency medicine trisk 3470 3470
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FIGURE 111.22 Nondisplaced fracture of the olecranon in an 8-year-old boy (bottom arrow ).
Note the elevated fat pads (top arrows ).
Radial neck fractures are far more common in children than fractures of the radial
head, which tend to occur primarily in skeletally mature individuals. The cause of
injury is typically a fall onto an outstretched, supinated arm. On examination,
tenderness overlying the proximal radius strongly suggests the diagnosis,
although it is worth noting that patients occasionally present with pain referred to
the wrist ( Fig. 111.23 ). The most common fracture pattern extends through the
physis with a metaphyseal fragment (Salter–Harris type II) or through the neck
proper (3 to 4 mm distal to the epiphyseal plate). Elbow imaging may also reveal
a posterior fat pad on the lateral view if a hemarthrosis is present; however, when
the metaphysis alone is injured, a hemarthrosis may be absent and the fat pads
normal. In addition, attention should be paid on radiographs to the radiocapitellar
line to pick up subtle displacement of the radius. Radial neck fractures with less
