Radial neck fractures commonly occur in children and tend to be more prevalent at ages 9 to 10 years; they represent up to 10% of all pediatric elbow fractures. The mechanism of injury is usually a fall on an outstretched hand with a valgus compressive force across the elbow joint. The initial assessment should include an examination of the elbow joint, followed by plain radiographs of the elbow. Obtaining orthogonal projection with anteroposterior (AP) and lateral views of the elbow joint is key, and an oblique-lateral view known as the ‘Greenspan’ or radiocapitellar view may also be obtained to allow easier visualization of the radial head.
Classification of radial neck injuries is based on angulation between the radial head and neck. The Judet classification and O’Brien classification systems are most commonly used. Undisplaced fractures may be difficult to visualize on plain radiographs; an additional sign to look for is the posterior fat pad, which is sometimes present and is indicative of an occult fracture.