Capitellum Fractures in the Pediatric Population: A Case Report

Capitellum fractures are rare injuries in the pediatric population. Their diagnosis is particularly challenging due to the predominantly cartilaginous nature of the pediatric elbow, which often limits the sensitivity of conventional radiographs. Consequently, these fractures are frequently overlooked at initial presentation. We present the case of a nine-year-old boy who sustained indirect trauma to the left elbow after a fall from standing height. On clinical examination, the patient complained of pain, mainly in the lateral aspect of the elbow, with refusal to actively mobilize the joint and marked discomfort during passive motion. Initial plain radiographs were inconclusive. Given the high index of clinical suspicion, further evaluation with computed tomography (CT) was performed, which revealed a Kocher-Lorenz fracture of the capitellum (Bryan and Morrey type II). Surgical treatment was undertaken through a lateral elbow approach via the Kocher interval; open reduction and internal fixation of the osteochondral fragment was achieved using bioabsorbable chondral darts. At one-year follow-up, the patient was asymptomatic, had regained a full range of motion of the elbow, and radiographic evaluation demonstrated complete fracture consolidation. No complications were reported. This case highlights several key aspects of capitellum fractures in the pediatric population. First, it emphasizes the importance of maintaining a high index of suspicion in younger children presenting with elbow pain and inconclusive initial radiographs following trauma. Second, it underlines the crucial role of advanced imaging modalities, particularly CT scan, in confirming the diagnosis and accurately characterizing fracture morphology. Finally, it supports early recognition and surgical management with anatomical reduction and stable fixation as an effective treatment strategy for displaced capitellum fractures. Although larger studies are needed to establish standardized treatment protocols, this case adds to the growing body of evidence suggesting that timely diagnosis and meticulous surgical management can result in excellent clinical and functional outcomes in pediatric capitellum fractures.