MISDIAGNOSIS OF FRACTURES AROUND THE ELBOW, SUPRACONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN: A CASE PRESENTATION AND REVIEW OF CRITOE IN PEDIATRIC ELBOW ASSESSMENT

MEDICINE

Misdiagnosis of pediatric elbow fractures remains a significant challenge in emergency and orthopedic practice because of the complex anatomy of the developing elbow and the presence of multiple secondary ossification centers. Among fractures around the elbow, supracondylar fractures of the humerus are the most common, accounting for the majority of pediatric elbow injuries and occurring predominantly in children aged 5–11 years following a fall onto an outstretched hand. Delayed or missed diagnosis may result in serious complications, including malunion, neurovascular injury, compartment syndrome, and permanent functional impairment. This literature review evaluates factors contributing to the misdiagnosis of pediatric elbow fractures, with particular emphasis on supracondylar humeral fractures and the diagnostic value of the CRITOE mnemonic in radiographic assessment. A review of published literature demonstrates that interpretation of pediatric elbow radiographs is frequently complicated by incomplete ossification, variable appearance of ossification centers, and subtle fracture patterns. The CRITOE sequence—Capitellum, Radial head, Internal (medial) epicondyle, Trochlea, Olecranon, and External (lateral) epicondyle—provides a systematic framework for recognizing normal developmental anatomy and distinguishing ossification centers from fracture fragments. Understanding the expected order and timing of ossification improves diagnostic accuracy and reduces the risk of mistaking normal structures for fractures or overlooking true injuries. In addition, assessment of the anterior humeral line, radiocapitellar alignment, and fat-pad signs remains essential for identifying occult fractures. The literature consistently highlights that inadequate knowledge of pediatric elbow anatomy is a major contributor to diagnostic errors. Incorporating the CRITOE principle into routine radiographic evaluation enhances clinician confidence and facilitates early recognition of supracondylar and other elbow fractures. Improved education in pediatric musculoskeletal imaging and adherence to structured assessment protocols are critical for reducing missed injuries, preventing complications, and optimizing outcomes in children presenting with elbow trauma,

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