Useful Plain Radiographic Findings in Diagnosis of Pediatric Olecranon Fracture Complicated With Proximal Radial Fracture

Objective The aim of this study was to verify the use of initial plain radiographs, specifically the presence of a longitudinal crack on the olecranon, for diagnosing olecranon occult fractures in children. Methods We retrospectively reviewed all patients younger than 16 years who were diagnosed with proximal radial fractures treated at our hospital between April 1, 2006 and September 31, 2014. We included 22 patients (9 boys and 13 girls) with a mean age of 8.5 years. Three hand surgeons were blinded to each other's results after examining all the initial radiographs of the injured elbows. To diagnose the fracture, we evaluated computed tomography scans in 9 cases and follow-up radiographs in the other 13 cases. Finally, we classified the fractured olecranon into 3 types: medial crack, posterior flat, and posterior crack. Results Twelve cases (54.5%) had associated olecranon fractures. According to the fracture type of the olecranon, 3 cases were a medial crack, 5 were a posterior flat, and 3 were a posterior crack. Each type of fracture had characteristic findings on plain radiographs. The mean value for sensitivity was 97.2% (range, 91.7%–100%), and the specificity was 90.0% (90.0%). Conclusions Our data indicated that this easy, noninvasive use of plain radiographs for checking whether a longitudinal crack exists on the olecranon benefits the patient by preventing missed diagnoses of pediatric olecranon fractures.