1. Elbow Trauma

2. 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)

3. Normal Elbow Anatomy
Very important to be aware of pediatric growth centers
CRITOE

4. 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

5. 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)

6. 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

7. Distal humerus fractures
95% extend to articular surface
Classified according to relationship with condyle and shape of fracture line
Supracondylar, intercondylar, condylar and epicondylar

8. 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

9. 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

10. 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)

11. 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

12. 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.

13. 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

14. Isolated Ulnar Fractures
Distal shaft (Nightstick fx.)- direct
trauma
Proximal shaft (Monteggia’s fx.)-
fx. of proximal ulna with
dislocation of radius

15. 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

16. 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

17. 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

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