[Normal variants and pitfalls at the elbow joint]

Not all that looks fractured is broken-multipartite humeral epicondyles in children

Objective

Multipartite epicondyles may mimic fractures in the setting of pediatric elbow trauma. This study examines the prevalence of multipartite epicondyles during skeletal development and their association with pediatric elbow fractures.

Materials and methods

In this retrospective analysis, 4282 elbow radiographs of 1265 elbows of 1210 patients aged 0–17 years were reviewed. The radiographs were analyzed by two radiologists in consensus reading, and the number of visible portions of the medial and lateral epicondyles was noted. For elbows in which epicondylar ossification was not yet visible, the epicondyles were already fused with the humerus or could not be sufficiently evaluated due to projection issues or because osteosynthesis material was excluded. In total, 187 elbows were included for the lateral and 715 for the medial epicondyle analyses.

Results

No multipartite medial epicondyles were found in patients without history of elbow fracture, whereas 9% of these patients had multipartite lateral epicondyles (p < 0.01). Current or previous elbow fractures increased the prevalence of multipartite epicondyles, with significant lateral predominance (medial epicondyle + 9% vs. lateral + 24%, p < 0.0001). Including all patients regardless of a history of elbow fracture, multipartite medial epicondyles were observed in 3% and multipartite lateral epicondyles in 18% (p < 0.0001). There was no gender difference in the prevalence of multipartition of either epicondyle, regardless of a trauma history.

Conclusion

Multipartite medial epicondyles occur in patients with current or previous elbow fractures only, whereas multipartite lateral epicondyles may be constitutional. Elbow fractures increase the prevalence of multipartite epicondyles on both sides, with significant lateral predominance.

Key Points

• Multipartite medial epicondyles should be considered of traumatic origin.

• Multipartite lateral epicondyles may be constitutional.

• Elbow fractures increase the prevalence of multipartite epicondyles on both sides with lateral predominance.

Could the Prevalence and Distribution of Os Supratrochleare Dorsale and Patella Cubiti be the Key to Accurate Diagnosis?

BACKGROUND

The aim of this study was the prevalence of patella cubiti and os supratrochleare dorsale, and to detect the differences between genders.

MATERIALS AND METHODS

In the study, direct radiographs of 1646 people (959 females and 687 males), who presented to Fırat University Hospital between 01.01.2016 and 31.01.2019 and had elbow joint radiographs, were evaluated retrospectively. Of the radiographs evaluated, 346 were right and left elbow radiographs of the same people, 689 were just right elbow radiographs, and 611 were only left elbow radiographs.

RESULTS

The prevalence of os supratrochleare dorsale was 2.08% (20 in 959 women) in women, 2.62% (18 in 687 men) in men, and 2.3% (38 in 1646 people) in total. The prevalence of patella cubiti was found to be 0.42% (4 in 959 women) in women, 1.31% (9 in 687 men) in men, and 0.79% (13 in 1646 people) in total. In addition, the prevalence of both sesamoid bones only in the left elbow and in both elbows was determined with and without separation according to male-female genders.

CONCLUSION

We are of the opinion that knowing the prevalence and distribution of these sesamoid bones will help with establishing early and correct diagnoses for patients who present with complaints, such as elbow extension limitation and pain in the elbow area.