Elbow trauma
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Elbow Trauma. Elbow Trauma. 6% of all fractures and dislocations involve elbow Most common fractures differ between adults and children M.C. in adults- radial head and neck fxs. M.C. in children- supracondylar fxs. Complex anatomy requires 4 views for adequate interpretation

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Elbow Trauma

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Elbow trauma

Elbow Trauma


Elbow trauma1

Elbow Trauma

  • 6% of all fractures and dislocations involve elbow

  • Most common fractures differ between adults and children

    • M.C. in adults- radial head and neck fxs.

    • M.C. in children- supracondylar fxs.

  • Complex anatomy requires 4 views for adequate interpretation

    • AP in extension, medial oblique, lateral and axial olecranon (Jones view)


Normal elbow anatomy

Normal Elbow Anatomy

  • Very important to be aware of pediatric growth centers

    • CRITOE

http://www.radiologyassistant.nl/en/4214416a75d87

http://med_practice.byethost7.com/wp2/?p=21


Normal alignment

Normal Alignment

  • Anterior humeral line- line drawn along anterior surface of humeral cortex

    should pass through the middle

    third of the capitellum

  • Radiocapitellar line- Line

    drawn through the proximal

    radial shaft and neck

    should pass through to

    the articulating capitellum

http://imageinterpretation.co.uk/elbow.html


Signs of fracture

Signs of Fracture

  • Usual signs may not be readily visible

    • Fracture line, cortical disruption, etc.

  • Soft tissue signs can indicate fracture

    • Fat pad sign

      • On lateral, might see fat pad parallel to anterior humeral cortex, but should never see posterior fat pad

      • With effusion, anterior may be displaced and will be shaped like a sail (sail sign)


Fat pad sign

Fat Pad Sign

  • Posterior fat pad is normally buried in olecranon fossa and not visible

    • Becomes elevated and visible with joint uffusion

      • Effusion (acute capsular swelling) can be from any origin (hemorrhagic, inflammatory, infectious, traumatic, etc.)

  • Ant. fat pad may be obliterated, so post. Fat pad is more reliable when visible


Distal humerus fractures

Distal humerus fractures

  • 95% extend to articular surface

  • Classified according to relationship with condyle and shape of fracture line

    • Supracondylar, intercondylar, condylar and epicondylar


Supracondylar fractures

Supracondylar Fractures

  • Most common elbow fracture in children (60%)

  • Fracture line extends transversely or obliquely through distal humerus

    above the condyles

  • Distal fragment usually

    displaces posteriorly

Normal


Intercondylar fracture

Intercondylar fracture

  • Fracture line extends between medial and lateral condyles and extends to supracondylar region

    • Results and T or Y shaped configuration for fracture

  • Called trans-condylar if it extends through both condyles


Epicondylar fracture

Epicondylar fracture

  • Usually avulsion from traction of respective common flexor (medial) or extensor (lateral) tendons

  • Medial epicondyle

    avulsion common in

    sports with strong

    throwing motion

    (little leaguer’s elbow)


Fractures of proximal ulna

Fractures of Proximal Ulna

  • Olecranon fx.- direct trauma or avulsion by triceps tendon

  • Coronoid process fx.- avulsion by brachialis or impaction into trochlear fossa

    • Rarely isolated;

      usually associated

      with post. elbow

      dislocation


Fractures of proximal radius

Fractures of Proximal Radius

  • M.C. adult elbow fx. (50%)

  • FOOSH transmits force causing impaction of radial head into capitellum

  • Chisel fracture- incomplete fracture of radial head that extends to center of

    articular surface

  • Usual rad. signs (fx. Line, articular

    disruption) may not be visible

    • May be occult; fat pad sign is good

      indicator of occult fx.


Fractures of the forearm

Fractures of the forearm

  • Isolated ulnar fractures

  • Isolated radial fractures

  • Bony rings usually can't be fractured in one place without disruption somewhere else in the ring

  • 60% or forearm fractures involve both bones (BB fractures)

  • These fractures usually have associated displacement with angulation and rotation


Isolated ulnar fractures

Isolated Ulnar Fractures

  • Distal shaft (Nightstick fx.)- direct

    trauma

  • Proximal shaft (Monteggia’s fx.)-

    fx. of proximal ulna with

    dislocation of radius

http://radiographics.rsna.org/content/24/4/1009/F31.expansion.html

http://www.wheelessonline.com/ortho/monteggias_fracture


Isolated radial fractures

Isolated Radial Fractures

  • Most frequent is a Galeazzi’s fx. (reverse Monteggia’s fx.)

    • Fracture of distal radial shaft

      with dislocation of distal

      radioulnar joint

    • Rare, but serious injury

http://www.learningradiology.com/archives05/COW%20157-Galeazzi%20Fx/galeazzicorrect.htm


Dislocations of elbow

Dislocations of Elbow

  • 3rd m.c. dislocation in adults behind shoulder and interphalangeal joints

    • More common in children

  • Classified according to displacement of radius an ulna relative to humerus

    • Posterior, posterolateral, anterior, medial and anteromedial

  • Posterior and posterolateral or more most common

    • 85-90% of all elbow locations

    • 50% have associated fractures


Pulled elbow

Pulled Elbow

  • AKA nursemaid’s elbow

  • Occurs when child’s hand is pulled, tractioning arm and causing radial head to slip out from under annular ligament and trapping the ligament in the radiohumeral articulation

  • Immediate pain; stuck in mid-pronation due to pain

  • No radiographic pain

  • Supination reduces the dislocation and ends pain, usually during positioning of lateral radiograph


References

References

Yochum, T.R. (2005) Yochum and Rowe’s Essentials of Skeletal Radiology, Third Edition. Lippincott, Williams and Wilkins: Baltimore.


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