13-E/8.1   Simple intraarticular flake

The pattern of this fracture is an intraarticular shear fracture of the joint surface, which may be chondral or osteochondral.

Flake fractures may occur in association with elbow dislocations in the older child, or spontaneously in undiagnosed osteochondritis dissecans. A direct radiological sign of osteochondritis dissecans is the clearly visible sclerotic border around the fracture line on the main fragment.

A coronal fracture of the capitellum (chisel fracture) is a more common form of this injury and is often the result of high-energy trauma.

This fracture is only visible on an x-ray if there is a bony component, mostly seen in older children.

Additional ultrasonography and/or MRI are indicated if there is diagnostic uncertainty.

Relevant clinical features include:

• Fat pad sign
• Local clinical swelling
• Local anterior tenderness
• Painful restriction of motion

Older child (older than 6 years):

• The AP suggests a lateral condylar fracture, but the lateral view shows a large articular fragment, including the capitellum