Elbow x-ray: Difference between revisions
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[[File:Ant and post fat pad.png|thumb|Anterior and posterior fat pad signs (in a case of an undisplaced fracture of the radius head which is not visible directly).]] | [[File:Ant and post fat pad.png|thumb|Anterior and posterior fat pad signs (in a case of an undisplaced fracture of the radius head which is not visible directly).]] | ||
[[File:AnteriorFatPad (normal).png|thumb|A normal anterior fat pad in a non-fractured arm.]] | [[File:AnteriorFatPad (normal).png|thumb|A normal anterior fat pad in a non-fractured arm.]] | ||
* Are the fat pads normal? | *Are the fat pads normal? | ||
** A visible ant. fat pad is normal but if displaced anteriorly (Sail sign) it is abnormal | **A visible ant. fat pad is normal but if displaced anteriorly (Sail sign) it is abnormal | ||
** A visible post. fat pad is always abnormal | **A visible post. fat pad is always abnormal | ||
** What if have fat pad displacement but no fracture or displacement is identified? | **What if have fat pad displacement but no fracture or displacement is identified? | ||
*** Adults: Treat as radial head fx | ***Adults: Treat as radial head fx | ||
*** Peds: Be certain that neither an undisplaced supracondylar fracture nor a displaced internal epicondyle fracture is overlooked! | ***Peds: Be certain that neither an undisplaced supracondylar fracture nor a displaced internal epicondyle fracture is overlooked! | ||
* Is the radiocapitellar line normal? | *Is the radiocapitellar line normal? | ||
** A line drawn along the longitudinal axis of the radial head and neck should pass through the capitellum | **A line drawn along the longitudinal axis of the radial head and neck should pass through the capitellum | ||
*** If line does not pass through capitellum then dislocation of radial head is probable | ***If line does not pass through capitellum then dislocation of radial head is probable | ||
** Whenver there is a fracture of the ulnar shaft must evaluate the radiocapitellar line for poss radial head dislocation (Monteggia fracture dislocation) | **Whenver there is a fracture of the ulnar shaft must evaluate the radiocapitellar line for poss radial head dislocation (Monteggia fracture dislocation) | ||
** This rule is always valid on a true lateral film | **This rule is always valid on a true lateral film | ||
*** In peds cases the AP view may be misleading | ***In peds cases the AP view may be misleading | ||
* Is the anterior humeral line normal? | *Is the anterior humeral line normal? | ||
** A line drawn along the ant cortex of the humerus will have at leats 1/3 of the capitellum anterior to it | **A line drawn along the ant cortex of the humerus will have at leats 1/3 of the capitellum anterior to it | ||
*** If less than 1/3 then strong probability of supracondylar fracture w/ distal fragment displaced posteriorly | ***If less than 1/3 then strong probability of supracondylar fracture w/ distal fragment displaced posteriorly | ||
* Are the ossification centers normal? | *Are the ossification centers normal? | ||
** CRITOE (Capitellum, Radial head, Internal epicondyle, Trochlea, Olecranon, Lateral Epicondyle) | **CRITOE (Capitellum, Radial head, Internal epicondyle, Trochlea, Olecranon, Lateral Epicondyle) | ||
*** Dislocated elbow may result in avulsion of internal epicondyle | ***Dislocated elbow may result in avulsion of internal epicondyle | ||
**** Because the trochlea ossifies after the internal epicondyle if you see the trochlea you must find the epicondyle! | ****Because the trochlea ossifies after the internal epicondyle if you see the trochlea you must find the epicondyle! | ||
==See Also== | ==See Also== | ||
Revision as of 08:51, 5 July 2016
Four Questions
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- Are the fat pads normal?
- A visible ant. fat pad is normal but if displaced anteriorly (Sail sign) it is abnormal
- A visible post. fat pad is always abnormal
- What if have fat pad displacement but no fracture or displacement is identified?
- Adults: Treat as radial head fx
- Peds: Be certain that neither an undisplaced supracondylar fracture nor a displaced internal epicondyle fracture is overlooked!
- Is the radiocapitellar line normal?
- A line drawn along the longitudinal axis of the radial head and neck should pass through the capitellum
- If line does not pass through capitellum then dislocation of radial head is probable
- Whenver there is a fracture of the ulnar shaft must evaluate the radiocapitellar line for poss radial head dislocation (Monteggia fracture dislocation)
- This rule is always valid on a true lateral film
- In peds cases the AP view may be misleading
- A line drawn along the longitudinal axis of the radial head and neck should pass through the capitellum
- Is the anterior humeral line normal?
- A line drawn along the ant cortex of the humerus will have at leats 1/3 of the capitellum anterior to it
- If less than 1/3 then strong probability of supracondylar fracture w/ distal fragment displaced posteriorly
- A line drawn along the ant cortex of the humerus will have at leats 1/3 of the capitellum anterior to it
- Are the ossification centers normal?
- CRITOE (Capitellum, Radial head, Internal epicondyle, Trochlea, Olecranon, Lateral Epicondyle)
- Dislocated elbow may result in avulsion of internal epicondyle
- Because the trochlea ossifies after the internal epicondyle if you see the trochlea you must find the epicondyle!
- Dislocated elbow may result in avulsion of internal epicondyle
- CRITOE (Capitellum, Radial head, Internal epicondyle, Trochlea, Olecranon, Lateral Epicondyle)
See Also
References
- Accident and Emergency Radiology
Video
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