Differential Diagnosis for a 7-year-old who fell onto her elbow

• Single most likely diagnosis:
  • Fracture of the supracondylar humerus: This is the most common elbow fracture in children, especially in the 5-7 year age group, and typically occurs when a child falls onto an outstretched hand with the elbow straight.
• Other Likely diagnoses:
  • Radial head or neck fracture: These fractures can occur from a fall onto an outstretched hand and are common in children.
  • Elbow dislocation: Although less common than fractures, elbow dislocations can occur in children and may be associated with fractures.
  • Soft tissue injury (e.g., bruising, sprain): Direct trauma to the elbow can cause soft tissue injuries, which may not be as severe as fractures but can still be painful and require medical attention.
• Do Not Miss diagnoses:
  • Vascular injury: A fracture or dislocation can compromise blood flow to the arm, leading to serious complications if not promptly addressed.
  • Nerve injury: The proximity of nerves to the elbow joint means that fractures or dislocations can cause nerve damage, which may result in numbness, tingling, or weakness in the arm or hand.
  • Compartment syndrome: Increased pressure within the muscle compartments of the arm can occur after a fracture or severe injury, leading to serious complications if not recognized and treated promptly.
• Rare diagnoses:
  • Monteggia fracture (fracture of the ulna with dislocation of the proximal radius): This is a less common injury that can occur from a fall onto an outstretched hand.
  • Medial epicondyle fracture: Although fractures of the medial epicondyle can occur, they are less common than other types of elbow fractures in children.
  • Osteochondritis dissecans of the capitellum: This is a rare condition where a piece of cartilage and bone in the elbow joint becomes damaged due to repetitive stress or trauma, more commonly seen in older children and adolescents involved in sports.