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Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
Mechanism is hyperextension due to a fall on an outstretched hand. Sixty percent of all childhood elbow fractures are supracondylar.
The posterior fat pad is the olecranon fossa fat pad and it should normally never be seen. The anterior fat pad is the coronoid fossa fat pad and it may be normally seen, but should not be seen to be elevated. In a transcondylar fracture there is a fracture line through the coronoid and olecranon fossae and there is posterior displacement or angulation of the distal fragment in the majority of cases. There are three lines to draw on elbow films which can help in the diagnosis of fractures.
1. Anterior humeral line - drawn tangential to the anterior humeral cortex and it should bisect the middle third of the ossification center of capitellum. In a supracondylar fracture this line passes anterior to the normal location.
2. Radiocapitellar line - drawn through the axis of the radius and passes through the capitellum on all views confirming normal articulation of the radial head and capitellum. If the line does not pass through the capitellum there is probable displacement of the radial head.
3. Coronoid line - outlines the coronoid fossa and when extended anteriorly should touch or project in front of capitellum and the coronoid line may define anterior or posterior dislocation of the capitellum.
See References Chapter.
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