Anyone who has ever carried a pager in an institution where children may come through the door knows how difficult pediatric elbow fractures can be. There aren’t many other injuries that frequently display such a large discrepancy between clinical presentation and radiographic findings. The ossification centers in the pediatric elbow are late to calcify, and severe injuries can be easily missed on radiographs.
However, the clinical presentation of pain, deformity, and excessive swelling should alert the clinician that something serious is occurring in the elbow. Surgical management will often find the surgeon attempting to reduce tiny bones in a grossly swollen arm. Mastering the skill of safe percutaneous pinning of the pediatric elbow fracture takes time, and, even in the most experienced hands, the outcome is not always satisfactory.
The article by Vallila et al., analyzing compensation claims following 7909 distal humeral fractures in children, investigates a complex and highly litigious area of pediatric orthopaedic trauma. Although it provides insight into Finland’s compensation and medicolegal world, the financial value placed on claims is not comparable with that placed on claims in other nations, due to the inherent variability of national medicolegal cultures. The real value of this article lies in the analysis of the complications that led to the compensation claims. Approximately 1% of the children who underwent a procedure for a distal humeral fracture experienced a complication deemed severe enough to merit compensation.
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