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| ==Four Questions==
| | #REDIRECT[[Elbow diagnoses]] |
| # Are the fat pads normal? | |
| ## A visible ant. fat pad is normal but if displaced anteriorly (Sail sign) it is abnormal
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| ## A visible post. fat pad is always abnormal
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| ## What if have fat pad displacement but no fx or displacement is identified?
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| ### Adults: Treat as radial head fx
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| ### Peds: Be certain that neither an undisplaced supracondylar fx nor a displaced internal epicondyle fx is overlooked!
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| # Is the radiocapitellar line normal?
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| ## A line drawn along the longitudinal axis of the radial head and neck should pass through the capitellum
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| ### If line does not pass through capitellum then dislocation of radial head is probable
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| ## Whenver there is a fx of the ulnar shaft must evaluate the radiocapitellar line for poss radial head dislocation (Monteggia fx dislocation)
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| ## This rule is always valid on a true lateral film
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| ### In peds cases the AP view may be misleading
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| # Is the anterior humeral line normal?
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| ## A line drawn along the ant cortex of the humerus will have at leats 1/3 of the capitellum anterior to it
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| ### If less than 1/3 then strong probability of supracondylar fx w/ distal fragment displaced posteriorly
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| # Are the ossification centers normal?
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| ## CRITOE (Capitellum, Radial head, Internal epicondyle, Trochlea, Olecranon, Lateral Epicondyle)
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| ### Dislocated elbow may result in avulsion of internal epicondyle
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| #### Because the trochlea ossifies after the internal epicondyle if you see the trochlea you must find the epicondyle!
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| ==ADULT INJURIES==
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| ===Radial Head/Neck Fractures===
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| # 50% of elbow injury in adults
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| # see Elbow Fx lect
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| ===Olecranon Fx===
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| # 2nd most common
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| # 20%
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| # direct blow
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| # pain,swelling, can't extend elbow
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| # OR if > 2 mm stepoff
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| ===Elbow D/L===
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| # 3rd most common jt D/L
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| # 90% post or postlateral
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| # 50% have assoc injuries, most common is med epicondylar fx that can often get entrapped
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| # prox radius & coronoid also Fxed
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| # ulnar injury - 8-21% in post D/L
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| # higher rate of neurovasc injury in anterior D/L
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| # Long arm post splint
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| ===Monteggia Fx/D/L===
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| #Type I - prox 1/3 of ulna, ant displ of distal ulna & ant disl of radial head
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| ##80%
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| #Type II - post displ of distal ulna & post D/L or radial head (20%)
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| # Dislocation of radial head requires ORIF
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| ==See Also==
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| [[Elbow (Minor)]]
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| [[Supracondylar]]
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| [[Elbow Xray Peds]] | |
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| ==Source==
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| Whiting lect 2001- By Lampe
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| [[Category:Ortho]]
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