Presentation
Pain and swelling after falling on the outstretched arm
Patient Data
There is a fracture line below the radial head ossification center. The capitellum, radial head, and internal epicondyle ossification centers can be observed as expected of a 7-year old. Sail sign and posterior fat pad sign indicate elbow joint effusion.
The fracture line passes across the growth plate and through the metaphysis, characterizing a type 2 Salter-Harris fracture.
Sail sign and posterior fat pad sign indicating elbow joint effusion (red highlights).
Normal appearance of the elbow ossification centers (blue highlights) at 7 years.
Case Discussion
The present case is a type 2 Salter-Harris fracture as the fracture line passes across the growth plate and through the metaphysis.
Salter-Harris classification is used to describe physeal fractures. The classification can be remembered using the SALTR mnemonic:
- S: slipped (type I)
- A: above or away from joint (type II)
- L: lower (type III)
- T: through or transverse or together (type IV)
- R: ruined or rammed (type V)
In a pediatric elbow radiograph evaluation, it is important to be familiar with the expected ossification centers' appearance by age. They can be remembered using the CRITOE mnemonic:
- C: capitellum
- R: radial head:
- I: Internal (medial) epicondyle
- T: trochlea
- O: olecranon
- E: external (lateral) epicondyle
Case contributed by Dr. Francisco Abaeté, M.D., PhD.
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