Elbow Fracture

Four Questions

1. Are the fat pads normal?
   1. A visible ant. fat pad is normal but if displaced anteriorly (Sail sign) it is abnormal
   2. A visible post. fat pad is always abnormal
   3. What if have fat pad displacement but no fx or displacement is identified?
      1. Adults: Treat as radial head fx
      2. Peds: Be certain that neither an undisplaced supracondylar fx nor a displaced internal epicondyle fx is overlooked!
2. Is the radiocapitellar line normal?
   1. A line drawn along the longitudinal axis of the radial head and neck should pass through the capitellum
      1. If line does not pass through capitellum than dislocation of radial head is probable
   2. Whenver there is a fx of the ulnar shaft must evaluate the radiocapitellar line for poss radial head dislocation (Monteggia fx dislocation)
   3. This rule is always valid on a true lateral film
      1. In peds cases the AP view may be misleading
3. Is the anterior humeral line normal?
   1. A line drawn along the ant cortex of the humerus will have at leats 1/3 of the capitellum anterior to it
      1. If less than 1/3 then strong probability of supracondylar fx w/ distal fragment displaced posteriorly
4. Are the ossification centers normal?
   1. CRITOE (Capitellum, Radial head, Internal epicondyle, Trochlea, Olecranon, Lateral Epicondyle)
      1. Dislocated elbow may result in avulsion of internal epicondyle
         1. Because the trochlea ossifies after the internal epicondyle if you see the trochlea you must find the epicondyle!

ADULT INJURIES

Radial Head/Neck Fractures

1. 50% of elbow injury in adults
2. see Elbow Fx lect

Olecranon Fx

1. 2nd most common
2. 20%
3. direct blow
4. pain,swelling, can't extend elbow
5. OR if > 2 mm stepoff

Elbow D/L

1. 3rd most common jt D/L
2. 90% post or postlateral
3. 50% have assoc injuries, most common is med epicondylar fx that can often get entrapped
4. prox radius & coronoid also Fxed
5. ulnar injury - 8-21% in post D/L
6. higher rate of neurovasc injury in anterior D/L
7. Long arm post splint

Monteggia Fx/D/L

1. Type I - prox 1/3 of ulna, ant displ of distal ulna & ant disl of radial head
   1. 80%
2. Type II - post displ of distal ulna & post D/L or radial head (20%)
3. Dislocation of radial head requires ORIF

See Also

Elbow Fracture Elbow (Minor) Supracondylar Elbow Xray Peds

Source

Whiting lect 2001- By Lampe