Presentation
Fall onto the outstretched hand. Painful and swollen right elbow.
Patient Data
Thin undisplaced sliver on the frontal view proximal to the capitellum ossification center indicating a lateral condylar fracture. The fracture passes around the capitellum, in keeping with a Milch type 2 fracture.
Discrete elbow joint effusion noticed by the sail sign.
Case Discussion
Lateral humeral condyle fractures are the second most common elbow fractures in children. They usually result from a fall onto the outstretched hand with the elbow in full extension or a sharp blow to the palm with the elbow in flexion.
Milch type 2 fractures are unstable and go through the trochlear groove to apex (around the capitellum). They can be also classified as a Salter-Harris type II physeal fracture.
In the present case, there was discrete elbow joint effusion, noticeable by the sail sign.
Finally, it's important to be familiar with the elbow ossification centers when assessing a pediatric elbow. In this case, only the capitellum, radial head, and medial epicondyle ossification centers are visible, which is normal given the patient's age.