* There is pain and swelling about the elbow. Bleeding at the fracture results in a large effusion in the elbow joint. * Depending on the fracture displacement, there may be deformity. With severe displacement, there may be an anterior dimple from the proximal bone end trapped within the biceps muscle. * The skin is usually intact. If there is a laceration that communicates with the fracture site, it is an open fracture, which increases infection risk. For fractures with significant displacement, the bone end can be trapped within the biceps muscle with resulting tension producing an indentation to the skin, which is called a "pucker sign". * The vascular status must be assessed, including the warmth and perfusion of the hand, the time for capillary refill, and the presence of a palpable radial pulse. Limb vascular status is categorized as "normal," "pulseless with a (warm, pink) perfused hand," or "pulseless–pale (nonperfused)" (see "neurovascular complications" below). * The neurologic status must be assessed including the sensory and motor function of the radial, ulnar, and median nerves (see "neurovascular complications" below). Neurologic deficits are found in 10-20% of patients. The mostly commonly injured nerve is the median nerve (specifically, the anterior interosseous portion of the median nerve). Injuries to the ulnar and radial nerves are less common. X-rays Diagnosis is confirmed by x-ray imaging. Antero-posterior (AP) and lateral view of the elbow joint should be obtained. Any other sites of pain, deformity, or tenderness should warrant an X-ray for that area too. X-ray of the forearm (AP and lateral) should also be obtained for because of the common association of<unk>  fractures with the fractures of the forearm. Ideally, splintage should be used to immobilise the elbow at 20 to 30 degrees flexion in order to prevent further injury of the blood vessels and nerves while doing X-rays. Splinting of fracture site with full flexion or extension of the elbow is not recommended as it can stretch the blood vessels and nerves over the bone fragments or can cause impingement of these structures into the fracture site. Depending on the child's age, parts of the bone will still be developing and if not yet calcified, will not show up on the X-rays. The capitulum of the<unk>  is the first to ossify at the age of one year. Head of radius and medial epicondyle of the<unk>  starts to ossify at 4 to 5 years of age, followed by trochlea of<unk>  and olecranon of the ulna at 8 to 9 years of age, and lateral epicondyle of the<unk>  to ossify at 10 years of age. Anterior X-ray Baumann's Angle Carrying angle can be evaluated through AP view of the elbow by looking at the Baumann’s angle. There are two definitions of Bowmann's angle: The first definition of Baumann's angle is an angle between a line parallel to the longitudinal axis of the humeral shaft and a line drawn along the lateral epicondyle. Another definition of Baumann's angle is also known as the humeral-capitellar angle. It is the angle between the line perpendicular to the long axis of the<unk>  and the growth plate of the lateral condyle. Reported normal values for Baumann's angle range between 9 and 26°. An angle of more than 10° is regarded as acceptable. Lateral X-ray On lateral view of the elbow, there are five radiological features should be looked for: tear drop sign, anterior humeral line, coronoid line, fish-tail sign, and fat pad sign/sail sign (anterior and posterior). Tear drop sign - Tear drop sign is seen on a normal radiograph, but is disturbed in<unk>  fracture. Anterior humeral line - It is a line drawn down along the front of the<unk>  on the lateral view and it should pass through the middle third of the capitulum of the<unk> . If it passes through the anterior third of the capitulum, it indicates the posterior displacement of distal fragment. Fat pad sign/sail sign - A non-displaced fracture can be difficult to identify and a fracture line may not be visible on the X-rays. However, the presence of a joint effusion is helpful in identifying a non-displaced fracture. Bleeding from the fracture expands the joint capsule and is visualized on the lateral view as a darker area anteriorly and posteriorly, and is known as the sail sign. Coronoid line - A line drawn along the anterior border of the coronoid process of the ulna should touch the anterior part of the lateral condyle of the<unk> . If lateral condyle appears posterior to this line, it indicates the posterior displacement of lateral condyle. Fish-tail sign - The distal fragment is rotated away from the proximal fragment, thus the sharp ends of the proximal fragment looks like a shape of a fish-tail. File:AnteriorandPSailSign.Anterior and posterior sail sign in a child who has a subtle<unk>  fracture File:Anterior humeral line.Anterior humeral line (black line), with normal area passed on the capitulum of the<unk>  colored in green in a 4 year old child. File:Anterior humeral line in a 6 month old child.The anterior humeral line is not reliable in children with sparse ossification of the capitulum, such as in this 6 months old child. Classification<unk>  fractures: Gartland classification Type Description I Non-displaced II Angulated with intact posterior cortex IIA Angulation IIB Angulation with rotation III Complete displacement but have perisosteal (medial/lateral) contact IIIA Medial periosteal hinge intact. Distal fragment goes posteromedially IIIB Lateral periosteal hinge intact. Distal fragment goes posterolaterally IV Periostial disruption with instability in both flexion and extension
Supracondylar humerus fracture
Radial head fracture
Proximal humerus fracture
Jefferson fracture
Bosworth fracture
Scapular fracture
Scaphoid fracture
Cuboid fracture