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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 95% extend to articular surface

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

    • Supracondylar, intercondylar, condylar and epicondylar


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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

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


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