How can doctors detect and treat a child's elbow fracture when the initial X-rays are inconclusive?

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Capitellum fractures are rare in children. Diagnosis is particularly challenging because the pediatric elbow is predominantly cartilaginous, which often limits the sensitivity of conventional X-rays. These fractures are therefore frequently overlooked at the initial presentation.

This single-patient case report describes a nine-year-old boy who sustained indirect trauma to his left elbow after falling from standing height. On examination, he reported pain mainly on the outer side of the elbow, refused to move the joint actively, and had marked discomfort when it was moved passively. Initial plain X-rays were inconclusive. Because clinical suspicion remained high, the team performed computed tomography (CT), which revealed a Kocher-Lorenz fracture of the capitellum, classified as Bryan and Morrey type II.

Surgeons used a lateral elbow approach through the Kocher interval. They performed open reduction and internal fixation of the osteochondral fragment using bioabsorbable chondral darts. At the one-year follow-up, the boy had no symptoms and had regained the full range of elbow motion; X-rays showed complete fracture consolidation. No complications were reported.

The case highlights several aspects of pediatric capitellum fractures. It emphasizes maintaining a high level of suspicion in younger children with elbow pain after trauma when initial X-rays are inconclusive. It also underlines the crucial role of advanced imaging, particularly CT, in confirming the diagnosis and accurately characterizing the fracture's shape and structure. The authors interpret the case as supporting early recognition and surgical management with anatomical reduction and stable fixation as an effective treatment strategy for displaced capitellum fractures.

Larger studies are needed to establish standardized treatment protocols. Within that limitation, this case adds to evidence suggesting that timely diagnosis and meticulous surgical management can result in excellent clinical and functional outcomes in children with capitellum fractures.