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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 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



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


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


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


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


  • Proximal shaft (Monteggia’s fx.)-

fx. of proximal ulna with

dislocation of radius



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


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

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