Paeds Trauma iSAWE 14

Question

An 8 year old boy falls from monkey bars onto his elbow.

Paeds Trauma iSAWE 14, lateral radiograph of the elbow
Lateral radiograph of the elbow. Image by James Heilman, MD, Wikimedia Commons, CC BY-SA 4.0.
  1. Describe the radiograph.
  2. What associated injuries do you look for?
  3. Outline treatment and the association with osteogenesis imperfecta.

Answer

Radiograph

  • Fracture of the olecranon (arrow)
  • Olecranon ossification centre appears at about 9 years and can mimic a fracture
  • Compare with the other elbow if unsure

Associated injuries

  • Radial head dislocation (Monteggia variant), check the radiocapitellar line
  • Radial neck fracture
  • Medial epicondyle fracture
  • Over 20% have another elbow injury

Treatment

  • Undisplaced (under 2 mm) or greenstick, cast in 60 to 90 degrees flexion for 3 weeks
  • Displaced, tension band wiring or plate
  • Absorbable sutures or tension band suture in young children
  • Flexion type fractures are stable in extension

Osteogenesis imperfecta

  • Apophyseal avulsion of the olecranon is linked with mild OI
  • Look for blue sclerae and family history
  • Contralateral fracture often follows

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.