Lateral and AP radiographs are usually sufficient, and in many instances demonstrate an obvious fracture. Often, however, no fracture line can be identified. In such cases assessing for indirect signs is essential:
Anterior fat pad sign (sail sign): the anterior fat pad is elevated by a joint effusion and appears as a lucent triangle on the lateral projection
Posterior fat pad sign
Anterior humeral line should intersect the middle third of the capitellum in most children although, in children under 4, the anterior humeral line may pass through the anterior third without injury
Anterior fat pad sign (sail sign): the anterior fat pad is elevated by a joint effusion and appears as a lucent triangle on the lateral projection
Posterior fat pad sign
Anterior humeral line should intersect the middle third of the capitellum in most children although, in children under 4, the anterior humeral line may pass through the anterior third without injury
True lateral elbow
Anterior humeral line should intersect with middle third of capitellum (see pediatric elbow alignment)
If not, consider<unk>  (or lateral condyle fracture)
Forearm/wrist views
Co-injuries are common with elbow fracture
Anterior humeral line should intersect with middle third of capitellum (see pediatric elbow alignment)
If not, consider<unk>  (or lateral condyle fracture)
If not, consider<unk>  (or lateral condyle fracture)
Co-injuries are common with elbow fracture
Type I
Nondisplaced with evidence of elbow effusion (ant sail sign and/or posterior fat pad)
Type II
Displaced with intact posterior periosteum
Anterior humeral line is displaced anteriorly relative to capitellum
Type III
Displaced with disruption of anterior and posterior periosteum
If distal fragment is posteromedially displaced: radial nerve injury
If distal fragment is posterolaterally displaced: median nerve, brachial artery injury
Type IV
Complete periosteal disruption with instability in flexion and extension
Nondisplaced with evidence of elbow effusion (ant sail sign and/or posterior fat pad)
Displaced with intact posterior periosteum
Anterior humeral line is displaced anteriorly relative to capitellum
Displaced with disruption of anterior and posterior periosteum
If distal fragment is posteromedially displaced: radial nerve injury
If distal fragment is posterolaterally displaced: median nerve, brachial artery injury
If distal fragment is posteromedially displaced: radial nerve injury
If distal fragment is posterolaterally displaced: median nerve, brachial artery injury
Complete periosteal disruption with instability in flexion and extension
Supracondylar fracture
Adult
Jefferson fracture
Proximal
Torus fracture
Shaft
Pisiform fracture
Distal