Presentation
Fall onto the outstretched hand while playing.
Patient Data
Minimally displaced (< 2 mm) supracondylar fracture of the humerus, in keeping with a Gartland type I supracondylar fracture.
Moderate elbow joint effusion is noted by the sail sign and the posterior fat pad sign.
Case Discussion
Supracondylar fractures are the most common elbow fractures in children. Falling onto the outstretched hand with the elbow in full extension is the main mechanism of injury.
Gartland type I fractures are undisplaced or minimally displaced (< 2 mm) supracondylar fractures. Sometimes, fracture lines are difficult to be seen on Gartland type I fractures. In these cases, it is important to look for indirect signs of a supracondylar fracture, such as:
presence of elbow joint effusion;
the anterior humeral line does not intersect the middle third of the capitellum.
The anterior humeral line (not drawn) was passing through the anterior third of the capitellum, suggesting some displacement.
Finally, it's important to be familiar with the elbow ossification centers when assessing a pediatric elbow and not mistake them for fractures.