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| ===Four Questions===
| | #REDIRECT[[Elbow diagnoses]] |
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| * Are the fat pads normal?
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| * 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 than 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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| 1. 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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| 2. Olecranon Fx - 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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| 3. 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
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| common is med epicondylar fx that
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| 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
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| 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
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| distal ulna & ant disl of radial head
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| 80%
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| Type II - post displ of distal ulna &
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| 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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| Ortho: Elbow Fracture
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| Ortho: Elbow (Minor)
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| Peds: Supracondylar
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| Rads: Elbow Xray Peds
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| ==Source==
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| Whiting lect 2001- By Lampe
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| [[Category:Ortho]] | |
