Semin Musculoskelet Radiol 2024; 28(04): 396-407
DOI: 10.1055/s-0044-1787121
Review Article

Imaging Assessment of the Pediatric Elbow: Developmental Variants and Common Pathologies

1   Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
2   Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
,
Hamza Alizai
1   Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
2   Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
,
Adam C. Zoga
3   Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Jefferson, Philadelphia, Pennsylvania
,
Jie C. Nguyen
1   Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
2   Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
› Author Affiliations

Abstract

The pediatric elbow is a complex joint that undergoes rapid growth and development. The normal anatomy of the elbow varies depending on the age of the patient, which can be challenging for imaging interpretation. This article reviews developmental variants and common pathologies of the pediatric elbow, with a focus on their radiologic features. Normal anatomy and development of the pediatric elbow are discussed, including the six ossification centers and elbow alignment. Congenital anomalies such as longitudinal deficiencies of the upper extremity are reviewed. Some common injuries that affect the elbow, such as supracondylar fracture, lateral condyle fracture, medial epicondyle avulsion, and radial head dislocation are also described.



Publication History

Article published online:
29 July 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Chauvin NA, Victoria T, Khwaja A, Dahmoush H, Jaramillo D. Magnetic resonance imaging of the fetal musculoskeletal system. Pediatr Radiol 2020; 50 (13) 2009-2027
  • 2 Pilling D. Fetal Radiology: A Diagnostic Atlas. By R Schumacher, L H Seaver and J Spranger. pp. viii+194, 2004 (Springer-Verlag, Berlin, Heidelberg, New York). Br J Radiol 2005; 78 (928) 376
  • 3 Al-Qattan MM, Yang Y, Kozin SH. Embryology of the upper limb. J Hand Surg Am 2009; 34 (07) 1340-1350
  • 4 Iyer RS, Thapa MM, Khanna PC, Chew FS. Pediatric bone imaging: imaging elbow trauma in children—a review of acute and chronic injuries. AJR Am J Roentgenol 2012; 198 (05) 1053-1068
  • 5 Fliegel BE, Ekblad J, Varacallo M. Anatomy, shoulder and upper limb, elbow annular ligament. StatPearls Publishing; 2024. Available at: https://www.researchgate.net/publication/332230543_Anatomy_Shoulder_and_Upper_Limb_Elbow_Annular_Ligament Accessed May 6, 2024
  • 6 Patel B, Reed M, Patel S. Gender-specific pattern differences of the ossification centers in the pediatric elbow. Pediatr Radiol 2009; 39 (03) 226-231
  • 7 Cheng JC, Wing-Man K, Shen WY. et al. A new look at the sequential development of elbow ossification centers in children. J Pediatr Orthop 1998; 18 (02) 161-167
  • 8 Diméglio A, Charles YP, Daures JP, de Rosa V, Kaboré B. Accuracy of the Sauvegrain method in determining skeletal age during puberty. J Bone Joint Surg Am 2005; 87 (08) 1689-1696
  • 9 Lee SY, Im SA. Comparison of bone ages in early puberty: computerized Greulich-Pyle based bone age vs. Sauvegrain method. J Korean Soc Radiol 2022; 83 (05) 1081-1089
  • 10 Keats TE, Anderson MW. Atlas of Normal Roentgen Variants That May Simulate Disease. 9th ed.. Philadelphia, PA: Saunders; 2012: 816
  • 11 McCarthy SM, Ogden JA. Radiology of postnatal skeletal development. VI. Elbow joint, proximal radius, and ulna. Skeletal Radiol 1982; 9 (01) 17-26
  • 12 Brubacher JW, Dodds SD. Pediatric supracondylar fractures of the distal humerus. Curr Rev Musculoskelet Med 2008; 1 (3-4): 190-196
  • 13 Fader LM, Laor T, Eismann EA, Cornwall R, Little KJ. Eccentric capitellar ossification limits the utility of the radiocapitellar line in young children. J Pediatr Orthop 2016; 36 (02) 161-166
  • 14 Shon HC, Park JK, Kim DS, Kang SW, Kim KJ, Hong SH. Supracondylar process syndrome: two cases of median nerve neuropathy due to compression by the ligament of Struthers. J Pain Res 2018; 11: 803-807
  • 15 Norell HG. Roentgenologic visualization of the extracapsular fat; its importance in the diagnosis of traumatic injuries to the elbow. Acta Radiol 1954; 42 (03) 205-210
  • 16 Parker SE, Mai CT, Canfield MA. et al; National Birth Defects Prevention Network. Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004-2006. Birth Defects Res A Clin Mol Teratol 2010; 88 (12) 1008-1016
  • 17 Swanson AB. Congenital limb defects classification and treatment. Clin Symp 1981; 33 (03) 1-32
  • 18 Bermejo-Sánchez E, Cuevas L, Amar E. et al. Phocomelia: a worldwide descriptive epidemiologic study in a large series of cases from the International Clearinghouse for Birth Defects Surveillance and Research, and overview of the literature. Am J Med Genet C Semin Med Genet 2011; 157C (04) 305-320
  • 19 Bhat AK, Acharya AM. Current concepts in the management of radial longitudinal deficiency. J Clin Orthop Trauma 2020; 11 (04) 597-605
  • 20 Goldfarb CA, Wall L, Manske PR. Radial longitudinal deficiency: the incidence of associated medical and musculoskeletal conditions. J Hand Surg Am 2006; 31 (07) 1176-1182
  • 21 Schmidt CC, Neufeld SK. Ulnar ray deficiency. Hand Clin 1998; 14 (01) 65-76
  • 22 Sachar K, Akelman E, Ehrlich MG. Radioulnar synostosis. Hand Clin 1994; 10 (03) 399-404
  • 23 Rutkowski PT, Samora JB. Congenital radioulnar synostosis. J Am Acad Orthop Surg 2021; 29 (13) 563-570
  • 24 Barik S, Farr S, Gallone G, Zarantonello P, Trisolino G, Di Gennaro GL. Results after treatment of congenital radioulnar synostosis: a systematic review and pooled data analysis. J Pediatr Orthop B 2021; 30 (06) 593-600
  • 25 Elliott AM, Kibria L, Reed MH. The developmental spectrum of proximal radioulnar synostosis. Skeletal Radiol 2010; 39 (01) 49-54
  • 26 Cleary JE, Omer Jr GE. Congenital proximal radio-ulnar synostosis. Natural history and functional assessment. J Bone Joint Surg Am 1985; 67 (04) 539-545
  • 27 Sachar K, Mih AD. Congenital radial head dislocations. Hand Clin 1998; 14 (01) 39-47
  • 28 Shrader MW. Pediatric supracondylar fractures and pediatric physeal elbow fractures. Orthop Clin North Am 2008; 39 (02) 163-171 , v
  • 29 Mallo G, Stanat SJC, Gaffney J. Use of the Gartland classification system for treatment of pediatric supracondylar humerus fractures. Orthopedics 2010; 33 (01) 19
  • 30 Campbell CC, Waters PM, Emans JB, Kasser JR, Millis MB. Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop 1995; 15 (01) 47-52
  • 31 Kuoppala E, Parviainen R, Pokka T, Sirviö M, Serlo W, Sinikumpu J-J. Low incidence of flexion-type supracondylar humerus fractures but high rate of complications. Acta Orthop 2016; 87 (04) 406-411
  • 32 Ogden JA. Skeletal Injury in the Child. 3rd ed.. New York, NY: Springer Nature; 2006: 340
  • 33 Jakob R, Fowles JV, Rang M, Kassab MT. Observations concerning fractures of the lateral humeral condyle in children. J Bone Joint Surg Br 1975; 57 (04) 430-436
  • 34 Koh KH, Seo SW, Kim KM, Shim JS. Clinical and radiographic results of lateral condylar fracture of distal humerus in children. J Pediatr Orthop 2010; 30 (05) 425-429
  • 35 Mintzer CM, Waters PM, Brown DJ, Kasser JR. Percutaneous pinning in the treatment of displaced lateral condyle fractures. J Pediatr Orthop 1994; 14 (04) 462-465
  • 36 Louahem DM, Bourelle S, Buscayret F. et al. Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases. Arch Orthop Trauma Surg 2010; 130 (05) 649-655
  • 37 Tariq SM, Patel V, Gendler L. et al. Pediatric thrower's elbow: maturation-dependent MRI findings in symptomatic baseball players. Pediatr Radiol 2024; 54 (01) 105-116
  • 38 Otoshi K, Kikuchi S, Kato K. et al. Age-specific prevalence and clinical characteristics of humeral medial epicondyle apophysitis and osteochondritis dissecans: ultrasonographic assessment of 4249 players. Orthop J Sports Med 2017; 5 (05) 2325967117707703
  • 39 Evans MC, Graham HK. Olecranon fractures in children: Part 1: a clinical review; Part 2: a new classification and management algorithm. J Pediatr Orthop 1999; 19 (05) 559-569
  • 40 Kalbitz M, Weber B, Lackner I, Beer M, Pressmar J. Olecranon fractures in children: treatment of a rare entity. Eur J Trauma Emerg Surg 2022; 48 (05) 3429-3437
  • 41 Rodts MF. Nursemaid's elbow: a preventable pediatric injury. Orthop Nurs 2009; 28 (04) 163-166 quiz 167–168
  • 42 Averill LW, Kraft DB, Sabado JJ, Atanda A, Long SS, Nazarian LN. Ultrasonography of the pediatric elbow. Pediatr Radiol 2023; 53 (08) 1526-1538
  • 43 Lee SH, Kim SG, Kwak D, Hong SH, Lee YK, Jang WY. The usefulness of ultrasound and the posterior fat pad sign in pulled elbow. Injury 2019; 50 (06) 1227-1231
  • 44 Bradley JP, Petrie RS. Osteochondritis dissecans of the humeral capitellum. Diagnosis and treatment. Clin Sports Med 2001; 20 (03) 565-590
  • 45 Wu M, Eisenberg K, Williams K, Bae DS. Radial head changes in osteochondritis dissecans of the humeral capitellum. Orthop J Sports Med 2018; 6 (04) 2325967118769059
  • 46 Nguyen JC, Degnan AJ, Barrera CA, Hee TP, Ganley TJ, Kijowski R. Osteochondritis dissecans of the elbow in children: MRI findings of instability. AJR Am J Roentgenol 2019; 213 (05) 1145-1151
  • 47 Bowen RE, Otsuka NY, Yoon ST, Lang P. Osteochondral lesions of the capitellum in pediatric patients: role of magnetic resonance imaging. J Pediatr Orthop 2001; 21 (03) 298-301