Introduction: Acute elbow trauma is commonly seen in the emergency department. The purpose of the present study was to evaluate in our emergency department the assessment of elbow trauma radiographs in children.

Methods: 136 patients aged between 0 and 16 presented at our institution for an elbow trauma over a 6 months period. All the radiographs were digitalised and stored in a commercially available computerised X ray system. All the radiographs were reviewed at the daily clinical radiological conference by an orthopaedic surgeon and a radiologist.

Results: There were 64 fractures, 2 dislocations, 37 radial head subluxations and 33 simple contusions. Of these, 15 (11 per cent) were considered to have been misinterpreted. There were 12 undisplaced fractures (5 supra-condylar fractures, 3 radial head fractures, one fracture of the lateral condyle, 3 fractures of the olecranon and 3 false-positive diagnoses of fractures. All patients were reviewed within a few days and were correctly reassessed and treated.

Conclusions: Compared to other fractures, children’s elbow trauma are commonly misdiagnosed in the emergency department. In this short series, correct diagnosis was missed 15 times (11%) by various physicians working in the Emergency Department (trainees, emergency physicians). The senior specialists (orthopaedic surgeon and radiologist) used real time digital contrast enhancement, as well as magnification and soft tissue assessment with the digitizer to correctly analyse the missed diagnosis. X ray review by senior specialists at the daily clinical radiological conference is time consuming and sometimes difficult but appears to be clearly beneficial to patients ‘care.