Elbow x-ray: Difference between revisions

Latest revision as of 18:48, 17 April 2024

Four Questions

Anterior and posterior fat pad signs (in a case of an undisplaced fracture of the radius head which is not visible directly).

A normal anterior fat pad in a non-fractured arm.

Anterior "Sail sign"

Normal pediatric elbow alignment

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 fracture
  - 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
- Whenever there is a fracture of the ulnar shaft must evaluate the radiocapitellar line for possible radial head dislocation (Monteggia fracture-dislocation)
- This rule is always valid on a true lateral film
  - In pediatric cases the AP view may be misleading
Is the anterior humeral line normal?
- A line drawn along the ant cortex of the humerus will have at least 1/3 of the capitellum anterior to it
  - If less than 1/3 then strong probability of supracondylar fracture with distal fragment displaced posteriorly
Are the ossification centers normal (pediatric patients only)?
- 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!

Elbow Ossification by Age (CRITOE)

Ossification Center	Age of Appearance (add 1yr for boys)
Capitellum	1yr
Radial head	3yr
Internal epicondyle	5yr
Trochlea	7yr
Olecranon	9yr
External epicondyle	11yr

References

Accident and Emergency Radiology

Authors:

@@ Line 2: / Line 2: @@
 [[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.]]
-* Are the fat pads normal?
+[[File:Elbow ant fat pad.jpg|thumb|Anterior "Sail sign"]]
-** A visible ant. fat pad is normal but if displaced anteriorly (Sail sign) it is abnormal
+[[File:Elbowalignment.png|thumb|Normal pediatric elbow alignment]]
-** A visible post. fat pad is always abnormal
+#Are the fat pads normal?
-** What if have fat pad displacement but no fx or displacement is identified?
+#*A visible ant. fat pad is normal but if displaced anteriorly (Sail sign) it is abnormal
-*** Adults: Treat as radial head fx
+#*A visible post. fat pad is always abnormal
-*** Peds: Be certain that neither an undisplaced supracondylar fx nor a displaced internal epicondyle fx is overlooked!
+#*What if have fat pad displacement but no fracture or displacement is identified?
-* Is the radiocapitellar line normal?
+#**Adults: Treat as radial head fracture
-** A line drawn along the longitudinal axis of the radial head and neck should pass through the capitellum
+#**Peds: Be certain that neither an undisplaced supracondylar fracture nor a displaced internal epicondyle fracture is overlooked!
-*** If line does not pass through capitellum then dislocation of radial head is probable
+#Is the radiocapitellar line normal?
-** Whenver there is a fx of the ulnar shaft must evaluate the radiocapitellar line for poss  radial head dislocation (Monteggia fx dislocation)
+#*A line drawn along the longitudinal axis of the radial head and neck should pass through the capitellum
-** This rule is always valid on a true lateral film
+#**If line does not pass through capitellum then [[radial head dislocation|dislocation of radial head]] is probable
-*** In peds cases the AP view may be misleading
+#*Whenever there is a fracture of the ulnar shaft must evaluate the radiocapitellar line for possible  [[radial head dislocation]] ([[Monteggia fracture-dislocation]])
-* Is the anterior humeral line normal?
+#*This rule is always valid on a true lateral film
-** A line drawn along the ant cortex of the humerus will have at leats 1/3 of the capitellum anterior to it
+#**In pediatric cases the AP view may be misleading
-*** If less than 1/3 then strong probability of supracondylar fx w/ distal fragment displaced posteriorly
+#Is the anterior humeral line normal?
-* Are the ossification centers normal?
+#*A line drawn along the ant cortex of the humerus will have at least 1/3 of the capitellum anterior to it
-** CRITOE (Capitellum, Radial head, Internal epicondyle, Trochlea, Olecranon, Lateral Epicondyle)
+#**If less than 1/3 then strong probability of [[supracondylar fracture]] with distal fragment displaced posteriorly
-*** Dislocated elbow may result in avulsion of internal epicondyle
+#Are the ossification centers normal (pediatric patients only)?
-**** Because the trochlea ossifies after the internal epicondyle if you see the trochlea you must find the epicondyle!
+#*[[CRITOE]] (Capitellum, Radial head, Internal epicondyle, Trochlea, Olecranon, Lateral Epicondyle)
+#**[[elbow dislocation|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!
+{{Elbow ossification by age DDX}}
 ==See Also==
-*[[Elbow Diagnoses]]
+*[[Elbow diagnoses]]
-*[[Elbow X-ray (Peds)]]
+*[[Elbow fractures (peds)]]
 ==References==
 *Accident and Emergency Radiology
-==Video==
+[[Category:Radiology]]
-{{*widget:YouTube|id=hxQVeN7nlhE}}
+[[Category:Pediatrics]]
+[[Category:Orthopedics]]
-[[Category:Rads]]