The Utility of the Radiocapitellar View in Pediatric Medial Epicondyle Fracture Evaluation.

Background: Anteroposterior (AP) and lateral radiographs often underestimate displacement in medial epicondyle fractures, further complicating the already debated operative indications. The radiocapitellar (RC) view is an alternative radiograph that allows for the separation of the humeroradial and humeroulnar joints. This study investigates the utility of the RC view in measuring displacement and identifying the need for operative intervention in pediatric medial epicondyle fractures.

Methods: A retrospective analysis was conducted on pediatric patients who presented to our institution with a medial epicondyle fracture treated operatively from 2015 to 2022 and received initial AP and RC radiographs. Fracture displacement was measured by 3 orthopaedic surgeons using the corresponding point measurement method and inter/intra-rater reliability was computed. A fracture >5 mm was considered to be within the threshold for recommendation of operative treatment. McNemar test was used to assess differences in sensitivity in detecting operative fractures between AP and RC radiographs, with a P-value of < 0.05 considered significant.

Results: A total of 45 patients met the inclusion criteria. The RC view had significantly higher sensitivity in identifying fractures greater than the operative threshold of 5 mm compared with the AP view (93.3% vs. 68.9%, P=0.0127), and on average, measured 2.5 mm more displacement (P<0.001) than the corresponding AP view. AP and RC radiographs both measured >5 mm of displacement in 62.2% (28/45) of fractures, with 6.7% (3/45) determined as >5 mm by AP view and ≤5 mm by RC view. 31.1% (14/45) of fractures were measured to be >5 mm by RC view and ≤5 mm by AP view.

Conclusion: The RC view significantly increases sensitivity in detecting the 5 mm displacement threshold for operative treatment of pediatric medial epicondyle fractures due to improved visualization of fracture displacement.

Level Of Evidence: Level III, diagnostic study.