Clinical Case Database / Category: Case Based Discussion

Common paediatric orthopaedic conditions

Publication details

A M Wood, MRC S Ed, DJ Bell
Foundation Years Journal, volume 2, issue 9, p.383 (123Doc Education, London, November 2008)


An 8-year-old boy presents with a painful right elbow following a fall from a swing onto an outstretched hand. The child is not known to be on the child protection register and is otherwise fit and well. On examination there is extensive swelling around the elbow. The child is reluctant to let you examine the elbow due to the pain, yet the radial and ulnar arteries are found to be present but weak, with a increased capillary refill time of 4 seconds. The child is neurologically intact distal to the injury. A lateral X-ray of the right elbow shows a “fat pad sign” on the lateral view and a visible fracture in the distal humerus with a distal fragment partially tilted and displaced posteriorly. It is not possible to get an anteroposterior (AP) view due to pain. In children under 10 years old, fractures of the elbow are the fourth most common fractures, and the second most common long bone fractures, second only to fractures of the distal radius and ulnar in their incidence. The majority of these injuries are supracondylar fractures, with a peak incidence in children 6–8 years old. The most common cause of injury is for the child to fall onto an outstretched hand and the elbow to be forced into either a valgus or varus direction.

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A M Wood, MRC S Ed (Corresponding author)

ST3 Trauma and Orthopaedics
Royal Infirmary of Edinburgh

DJ Bell (Corresponding author)

4th Year Medical Student
University of Leeds


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