Imaging Case of the Week 55

A 5 year old presents with FOOSH injury and a swollen elbow. His elbow x-rays are as follows. What do you notice?

 

elbow x-ray

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elbow lateral

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Answer
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  1. Effusion + anterior humeral line not passing through middle third capitulum = supracondylar fracture.
    However I believe this one of the very uncommon “flexion type” supracondylar fractures where the distal fragment is displaced anteriorly instead of the usual posterior displacement. Usually with supracondylar fractures, they occur in extension where they posterior displacement of the distal fragment means the anterior humeral line passes through the anterior third of the capitulum (instead of the middle third) or it misses the capitulum entirely passing anterior to it. However in this case the anterior humeral line passes posterior to the capitulum. This apparently only occurs in 2% of cases.
    Information re classification of supracondylar fractures
    http://www.rch.org.au/clinicalguide/guideline_index/fractures/Supracondylar_fracture_of_the_humerus_Emergency_Department/#Classification

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