old, with a peak incidence between ages and due to the relative strength of the collateral ligaments and joint capsule as compared to the bone FIGURE 111.16 Normal lateral radiograph of the elbow of a 2-year-old child The anterior fat pad is readily seen (arrow ); the posterior fat pad is not visible A line drawn along the anterior cortex of the humerus intersects the capitellum in its middle third (solid line ) A line drawn along the axis of the radius also passes through the center of the capitellum (dashed line ) Clinical assessment Supracondylar fractures commonly present with localized swelling and tenderness around the elbow on examination, with or without deformity of the distal humerus The presence of extensive swelling and ecchymosis of the elbow imparts a significant risk for compartment syndrome Any progression of increasing pain, or pain with passive extension of the fingers is concerning for ischemia and requires immediate orthopedic consultation A thorough examination of perfusion as well as motor and sensory function of the median, radial, and ulnar nerve distribution is essential ( Table 111.6 ) as nerve injuries are present in up to 15% of injuries and vascular compromise approaching 20% of injuries The median nerve—specifically the anterior