Predisposing Effect of Elbow Alignment on the Elbow Fracture Type in Children

Abstract

Objectives: Under the hypothesis that the elbow alignment, namely the carrying angle, could predispose individuals to a specific type of pediatric elbow fracture after a fall onto an outstretched arm, we investigated the relationship between radiographic carrying angle and elbow fracture type in children.

Design: Retrospective case-control study.

Setting: Level I pediatric trauma center.

Patients/participants: We reviewed 374 children who were diagnosed with supracondylar fracture (SCF, n = 208), lateral condylar fracture (LCF, n = 132), and radial neck fracture (RNF, n = 34).

Intervention: The association between the radiographic carrying angle and the fracture type was investigated.

Main outcome measurements: To adjust for bias, 2 statistical methods were used: multivariate analysis using a baseline-category logistic model and a case-matching method using propensity score analysis.

Results: In the multivariate analysis, with SCF patients set as the baseline category, a more valgus-deviated elbow (increased carrying angle, P = 0.011) predisposed individuals to RNF, whereas a more varus-deviated elbow (decreased carrying angle, P < 0.001) predisposed them to LCF. In the case-matched analysis, there were also significant differences in carrying angles between RNF and case-matched SCF patients (14.3 vs. 11.4 degrees, P = 0.013) and between LCF and case-matched SCF patients (7.7 vs. 11.7 degrees, P < 0.001).

Conclusions: Elbow alignment, which may influence the transmission of traumatic force during a fall onto an outstretched elbow, could be a predisposing factor for specific types of pediatric elbow fracture. The results provide the additional information about the injury mechanisms of pediatric elbow fracture and may deepen our understanding of the fractures.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.