Elbow Fracture

Four Questions

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

ADULT INJURIES

1. Radial Head/Neck Fractures

- 50% of elbow injury in adults

- see Elbow Fx lect

2. Olecranon Fx - 2nd most common

20%

- direct blow

- pain,swelling, can't extend elbow

- OR if > 2 mm stepoff

3. Elbow D/L

- 3rd most common jt D/L

- 90% post or postlateral

- 50% have assoc injuries, most

common is med epicondylar fx that

can often get entrapped

- prox radius & coronoid also Fxed

- ulnar injury - 8-21% in post D/L

- higher rate of neurovasc injury

in anterior D/L

- Long arm post splint

Monteggia Fx/D/L

Type I - prox 1/3 of ulna, ant displ of

distal ulna & ant disl of radial head

80%

Type II - post displ of distal ulna &

post D/L or radial head (20%)

- Dislocation of radial head requires ORIF

See Also

Ortho: Elbow Fracture

Ortho: Elbow (Minor)

Peds: Supracondylar

Rads: Elbow Xray Peds

Source

Whiting lect 2001- By Lampe