Elbow Trauma

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Elbow Trauma
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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)

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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/?p21
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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
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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)

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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

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Distal humerus fractures

• 95 extend to articular surface
• Classified according to relationship with condyle
  and shape of fracture line
• Supracondylar, intercondylar, condylar and
  epicondylar

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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
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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

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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 leaguers elbow)

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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

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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.

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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

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Isolated Ulnar Fractures

• Distal shaft (Nightstick fx.)- direct
• trauma
• Proximal shaft (Monteggias fx.)-
• fx. of proximal ulna with
• dislocation of radius

http//radiographics.rsna.org/content/24/4/1009/F3
1.expansion.html
http//www.wheelessonline.com/ortho/monteggias_fra
cture
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Isolated Radial Fractures

• Most frequent is a Galeazzis fx. (reverse
  Monteggias fx.)
• Fracture of distal radial shaft
• with dislocation of distal
• radioulnar joint
• Rare, but serious injury

http//www.learningradiology.com/archives05/COW20
157-Galeazzi20Fx/galeazzicorrect.htm
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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

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Pulled Elbow

• AKA nursemaids elbow
• Occurs when childs 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

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References

• Yochum, T.R. (2005) Yochum and Rowes Essentials
  of Skeletal Radiology, Third Edition. Lippincott,
  Williams and Wilkins Baltimore.