Abstract
TRASH lesions are a group of special injuries around the elbow resulting from high energy trauma that are routinely missed at initial presentation because of seemingly normal X-rays. These are a group of osteochondral injuries having a high propensity for surgical intervention and usually have poor outcomes if not treated adequately. Prompt diagnosis warrants a high index of suspicion even when a radiograph appears to be normal with a disproportionately swollen elbow in a child. TRASH lesions include radial head osteochondral fractures, medial condylar fractures in unossified elbow, transphyseal separations of the distal humerus, monteggia lesions, entrapped incarcerated medial epicondylar fractures, capitellar shear fractures, lateral condylar fractures extending to the cartilage. This article attempts to review in brief, the approach to early diagnosis and management with literature review and case examples.
Similar content being viewed by others
References
Brighton, B., & Vitale, M. (2015). Epidemiology of fractures in children. Rockwood and Wilkins’ Fractures in Children. pp. 1–7.
Beaty, J. H., & Kasser, J. R. (2015). Evaluation of pediatric distal humeral fractures. Rockwood and Wilkins’ fractures in children. 8th ed. Philadelphia: Lippincott Williams & Wilkins. pp. 565–579.
Waters, P. M., Beaty, J., & Kasser, J. E. (2010). TRASH” (The Radiographic Appearance Seemed Harmless) Lesions [Internet]. Journal of Pediatric Orthopaedics, 30, S77-81.
Leung, A. G., & Peterson, H. A. (2000). Fractures of the proximal radial head and neck in children with emphasis on those that involve the articular cartilage. Journal of Pediatric Orthopedics, 20(1), 7–14.
Van Zeeland, N. L., Bae, D. S., & Goldfarb, C. A. (2011). Intra-articular radial head fracture in the skeletally immature patient: Progressive radial head subluxation and rapid radiocapitellar degeneration. Journal of Pediatric Orthopedics, 31(2), 124–129.
Ackerson, R., Nguyen, A., Carry, P. M., Pritchard, B., Hadley-Miller, N., & Scott, F. (2015). Intra-articular radial head fractures in the skeletally immature patient: Complications and management. Journal of Pediatric Orthopedics, 35(5), 443–448.
Bell, S. N., Morrey, B. F., & Bianco, A. J., Jr. (1991). Chronic posterior subluxation and dislocation of the radial head. JBJS, 73(3), 392–396.
Leet, A. I., Young, C., & Hoffer, M. M. (2002). Medial condyle fractures of the humerus in children. Journal of Pediatric Orthopaedics., 22(1), 2–7.
Bensahel, H., Csukonyi, Z., Badelon, O., & Badaoui, S. (1986). Fractures of the medial condyle of the humerus in children. Journal of Pediatric Orthopaedics., 6(4), 430–433.
Harrison, R. B., Brent Harrison, R., Keats, T. E., Frankel, C. J., Anderson, R. L., & Youngblood, P. (1984). Radiographic clues to fractures of the unossified medial humeral condyle in young children [Internet]. Skeletal Radiology, 11, 209–212.
Fernandez, F. F., Vatlach, S., Wirth, T., & Eberhardt, O. (2019). Medial humeral condyle fracture in childhood: a rare but often overlooked injury [Internet]. European Journal of Trauma and Emergency Surgery, 45, 757–761.
Abzug, J., Ho, C. A., Ritzman, T. F., & Brighton, B. (2016). Transphyseal distal humerus fracture. Instructional Course Lectures, 65, 379–384.
Supakul, N., Hicks, R. A., Caltoum, C. B., & Karmazyn, B. (2015). Distal humeral epiphyseal separation in young children: an often-missed fracture-radiographic signs and ultrasound confirmatory diagnosis. AJR American Journal of Roentgenology, 204(2), W192–W198.
Kamaci, S., Danisman, M., & Marangoz, S. (2014). Neonatal physeal separation of distal humerus during cesarean section. American Journal of Orthopedics (Belle Mead NJ)., 43(11), E279–E281.
De Jager, L. T., & Hoffman, E. B. (1991). Fracture-separation of the distal humeral epiphysis. The Journal of Bone and Joint Surgery, 73(1), 143–146.
Abe, M., Ishizu, T., Nagaoka, T., & Onomura, T. (1995). Epiphyseal separation of the distal end of the humeral epiphysis: A follow-up note. Journal of Pediatric Orthopaedics, 15(4), 426–434.
Degreef, I., & De Smet, L. (2004). Missed radial head dislocations in children associated with ulnar deformation: Treatment by open reduction and ulnar osteotomy. Journal of Orthopaedic Trauma, 18(6), 375–378.
Lincoln, T. L., & Mubarak, S. J. (1994). “Isolated” traumatic radial-head dislocation. Journal of Pediatric Orthopedics, 14(4), 454–457.
Letts, M., Locht, R. A., & Wiens, J. O. (1985). Monteggia fracture-dislocations in children. The Journal of Bone and Joint Surgery, 67(5), 724–727.
Gottschalk, H. P., Eisner, E., & Hosalkar, H. S. (2012). Medial epicondyle fractures in the pediatric population. JAAOS-Journal of the American Academy of Orthopaedic Surgeons., 20(4), 223–232.
Stans, A. A., & Lawrence, J. T. (2015). Dislocations of the elbows, medial epicondylar humerus fractures. Rockwood and Wilkins’ fractures in children. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams&Wilkins.
Papavasiliou, V. A. (1982). Fracture-separation of the medial epicondylar epiphysis of the elbow joint. Clinical Orthopaedics and Related Research, 171, 172–174.
Marcu, D. M., Balts, J., McCarthy, J. J., Kozin, S. H., & Noonan, K. J. (2011). Iatrogenic radial nerve injury with cannulated fixation of medial epicondyle fractures in the pediatrichumerus: A report of 2 cases. Journal of Pediatric Orthopaedics, 31(2), e13–e16.
Letts, M., Rumball, K., Bauermeister, S., McIntyre, W., & D’Astous, J. (1997). Fractures of the capitellum in adolescents. Journal of Pediatric Orthopaedics., 17(3), 315–320.
Pradhan, B. B., Bhasin, D., & Krom, W. (2005). Capitellar fracture in a child [Internet]. The Journal of Bone & Joint Surgery, 87, 635–638.
Bryan, R. S. (1985). Fractures of the distal humerus. The Elbow and its Disorders. pp. 325–33.
McKee, M. D., Jupiter, J. B., & Bamberger, H. B. (1996). Coronal shear fractures of the distal end of the humerus. JBJS, 78(1), 49–54.
Agins, H. J., & Marcus, N. W. (1984). Articular cartilage sleeve fracture of the lateral humeral condyle capitellum: A previously undescribed entity. Journal of Pediatric Orthopedics, 4(5), 620–622.
Drvaric, D. M., & Rooks, M. D. (1990). Anterior sleeve fracture of the capitellum. Journal of Orthopaedic Trauma, 4(2), 188–192.
Suresh, S. S. (2009). Type 4 capitellum fractures: Diagnosis and treatment strategies. Indian Journal of Orthopaedics., 43(3), 286.
Song, K. S., Kang, C. H., Min, B. W., Bae, K. C., & Cho, C. H. (2007). Internal oblique radiographs for diagnosis of nondisplaced or minimally displaced lateral condylar fractures of the humerus in children. Journal of Bone and Joint Surgery. American Volume, 89(1), 58–63.
Song, K. S., & Waters, P. M. (2012). Lateral condylar humerus fractures: Which ones should we fix? Journal of Pediatric Orthopaedics., 1(32), S5-9.
Foster, D. E., Sullivan, J. A., & Gross, R. H. (1985). Lateral humeral condylar fractures in children. Journal of Pediatric Orthopedics., 5(1), 16–22.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical Standard Statement
This article does not contain any studies with human or animal subjects performed by the any of the authors.
Informed Consent
For this type of study informed consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Patwardhan, S., Omkaram, S. Trash Lesions Around the Elbow: A Review of Approach to Diagnosis and Management. JOIO 55, 539–548 (2021). https://doi.org/10.1007/s43465-020-00333-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43465-020-00333-x