Examining Elbow Radiographs

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Presentation transcript:

Examining Elbow Radiographs Elbow Trauma  Anatomy 3D  Dislocations Radial Head  Fractures Forearm Patterns Children Examining Elbow Radiographs schreibman.info

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy Capitellum Trochlea Radial Head Olecranon S Capitellum [L. small head] ball-shaped Trochlea [Gr. pulley] spool-shaped Radial Head disc-shaped Olecranon [Gr. elbow] TROC CAP OLEC U L N A HEAD R A D I U S

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy

Elbow Anatomy OLECRANON CORACOID CORONOID ON H U M E R S L A N D I CAP L N TROC OLECRANON CORACOID CORONOID ON

Elbow Anatomy OLECRANON CORONOID CORONOID ON H U M E R S L A N D I CAP L N TROC OLECRANON CORONOID CORONOID ON

Olecranon & Radial Head Easy! Elbow Dislocations Olecranon & Radial Head Easy! Relocated AP View AP View Lateral View

Elbow Dislocations: Parallelism Relocated Relocated Dislocated Parallel Articular Surfaces Lack of Parallelism Parallel Articular Surfaces AP View Lateral View AP View

Olecranon & Radial Head Easy! Radial Head Only Can be very subtle Elbow Dislocations Olecranon & Radial Head Easy! Radial Head Only Can be very subtle

Keys to Examining Elbows  1) Radial Head points to Capitellum on all views 2) 3) 4)

Elbow Anatomy H U M E R S A D I CAP L N TROC

Radial Head points to Capitellum Elbow Anatomy H U M E R S Radial Head points to Capitellum TROC CAP R A D I U S

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Radial Head points to Capitellum Elbow Anatomy Radial Head points to Capitellum

Congenital Radial Head Dislocation 4 year-old male No trauma Could not supinate arm Lateral AP Lateral Left Right

Olecranon & Radial Head Easy! Radial Head Only Can be very subtle Elbow Dislocations Olecranon & Radial Head Easy! Radial Head Only Can be very subtle

Monteggia Fracture 10 year-old female AP Lateral --------- Not a True Lateral True Lateral

Monteggia Fracture RADIUS HUMERUS CAP TROC CARPUS FALL ULNA

Monteggia Fracture RADIUS CAP CARPUS FALL HUMERUS TROC ULNA

Monteggia Fracture Post Reduction

Giovanni Battista Monteggia (1762-1815) Monteggia Fracture Giovanni Battista Monteggia (1762-1815) Greatest Italian Surgeon beginning 19th century Fx Prox 1/3 Ulna Ant Disloc Rad Head Hunter, Peltier, Lund RadioGraphics 2000:20;819-836

Monteggia Fracture Bado’s classification of Monteggia fractures Hunter, Peltier, Lund RadioGraphics 2000:20;819-836

Monteggia Fracture

Monteggia Fracture

Forearm Fractures RADIUS HUMERUS CAP TROC CARPUS FALL ULNA

Forearm Fractures : Galeazzi RADIUS HUMERUS CAP TROC CARPUS FALL ULNA

Galeazzi Fracture Riccardo Galeazzi (1866-1952) Developed Orthopedic Rehab in Italy Crippled soldiers/children wounded WWI Fracture Middle-Distal ⅓ Radius Dislocation of the Distal Radio-Ulnar Joint (DRUJ) Hunter, Peltier, Lund RadioGraphics 2000:20;819-836

Galeazzi Fracture << Monteggia Fracture Middle-Distal ⅓ Radius Dislocation of the Distal Radio-Ulnar Joint (DRUJ)

Monteggia vs Galeazzi: mnemonic HUMERUS ULNA CAP TROC CARPUS FALL RADIUS M MU/GR U G R RADIUS HUMERUS CAP TROC CARPUS FALL ULNA

Forearm Fractures : Nightstick Fx RADIUS HUMERUS CAP TROC CARPUS ULNA

Forearm Fractures : Nightstick Fx Chicago, 1968

Forearm Fractures : Nightstick Fx 2 months later

Both Bone Forearm Fracture Common in children Can look scary… …but should heal well “if both ends of the bone are in the same room”  RADIUS HUMERUS CAP TROC CARPUS FALL ULNA

Both Bone Forearm Fracture 7 Months Later 12 year-old Male AP View Lateral View

Essex-Lopresti Fracture RADIUS HUMERUS CAP TROC CARPUS FALL IOM ULNA

Essex-Lopresti Fracture Peter Gordon Essex-Lopresti (1918-1951) British Surgeon, Air Borne Div, WWII Expert on Parachuting Injuries Classification scheme for Calcaneal Fxs Radial Head Fx w/ Disruption DRUJ Displaced Rad Head Fx Examine Wrist Closely Hunter, Peltier, Lund RadioGraphics 2000:20;819-836

Essex-Lopresti Fracture Lack of Parallelism Impacted, Comminuted Radial Head Fracture

Essex-Lopresti Fracture Radial Head Prosthesis Impacted, Comminuted Radial Head Fracture

Essex-Lopresti Fracture Post Radial Head Prosthesis Lack of Parallelism Parallel articular surfaces

Keys to Examining Elbows  1) Radial Head points to Capitellum on all views Fat Pads are your Friend 2) 3) 4)

Elbow Fat Pads H U M E R S L N A CAP D I

Elbow Fat Pads With a radial head fracture: M E R S Anterior Fad Pad (Coronoid Fossa) Posterior Fad Pad (Olecranon Fossa) U L N A R A D U I S Resnick fig22-15 Resnick fig22-16 CAP With a radial head fracture: Bleeding into joint (hemarthrosis) Elevates the Fat Pads

Elbow Fat Pads Normally, can’t see Posterior Fat Pad (tucked in olecranon fossa) Anytime you can see it, indicates it is displaced… probably by hemarthrosis H U M E R S U L N A R A D U I S CAP

Elbow Fat Pads Normally, can’t see Posterior Fat Pad (tucked in olecranon fossa) Anytime you can see it, indicates it is displaced… probably by hemarthrosis H U M E R S U L N A R A D U I S CAP

Keys to Examining Elbows  1) Radial Head points to Capitellum on all views Fat Pads are your Friend Most Radial Head Fractures are non-displaced and hard to see Adults = Radial Head Fracture 2) 3) 4)

Elevated Fat Pad = Radial Head Fx U M E R S Lateral U L N A R A D U I S Oblique CAP AP

Elevated Fat Pad = Radial Head Fx EXT ROT

Radial Neck is Outside Joint Capsule Radial Neck fracture does not cause a hemarthrosis, and does not elevate the fat pads. Resnick fig22-15

Radial Neck is Outside Joint Capsule No Fat Pad Elevation Resnick fig22-15

Keys to Examining Elbows  1) Radial Head points to Capitellum on all views Fat Pads are your Friend Adults = Radial Head Fracture Children = Supracondylar Fx 2) 3) 4)

Anatomy H U M E R S TROC CAP U L N A R A D I U S

: Ossification Centers Articular surfaces unossified at birth Anatomy : Ossification Centers H U M E R S Articular surfaces unossified at birth Ossify in order C R I T O E Capitellum Rad Head Int (med) Epi Trochlea Olecranon Ext (lat) Epi 2 year-old female …..2 …..4 ..6 …….8 …10 ..12 CAP U L N A R A D I U S

Elbow Fractures: Children M E R S Supracondylar Fracture 60% Elbow Fxs in Children SubtleGrossly Displaced CAP U L N A R A D I U S

Elbow Fractures: Children M E R S Supracondylar Fracture 60% Elbow Fxs in Children SubtleGrossly Displaced 2 year-old female CAP U L N A R A D I U S Right (painful side) Left (normal side)

Elbow Fractures: Children Supracondylar Fracture 60% Elbow Fxs in Children SubtleGrossly Displaced Right (painful side) Left (normal side)

Supracondylar Fracture Anterior Humeral Line Should pass thru middle Capitellum Right (painful side) Left (normal side)

Keys to Examining Elbows  1) Radial Head points to Capitellum on all views Fat Pads are your Friend Adults = Radial Head Fracture Children = Supracondylar Fx Anterior Humeral Line Should pass thru middle ⅓ Capitellum 2) 3) 4)

Supracondylar Fracture Day of injury After 2 weeks After 5 weeks 5 year-old female

Keys to Examining Elbows  1) Radial Head points to Capitellum on all views Fat Pads are your Friend Adults = Radial Head Fracture Children = Supracondylar Fx (Lateral Condyle Fx) Anterior Humeral Line Should pass thru middle ⅓ Capitellum 2) 3) 4)

Elbow Fractures: Children Lateral Condyle Fracture 2nd most common pediatric elbow Fx 20% of elbow injuries in children

Elbow Fractures: Children Lateral Condyle Fracture 2nd most common pediatric elbow Fx 20% of elbow injuries in children 6 year-old female Right (normal side) Left (painful side)

Keys to Examining Elbows  1) Radial Head points to Capitellum on all views Fat Pads are your Friend Adults = Radial Head Fracture Children = Supracondylar Fx (Lateral Condyle Fx) Anterior Humeral Line Should pass thru middle ⅓ Capitellum When in doubt, get the other side 2) 3) 4)

Elbow Fractures: Children C R I T O E Capitellum Rad Head Int (med) Epi Trochlea Olecranon Ext (lat) Epi …..2 …..4 ..6 …….8 …10 ..12 E I C R T 14 year-old male O

Elbow Fractures: Children Avulsion Medial Epicondyle “Little Leaguer’s Elbow” Traction common tendon flexor- pronator group Traction UCL Result of valgus stress Fall on out- stretched hand Violent throwing contractions Width of normal growth plate Abnormally widened growth plate 14 year-old male Right (normal side) Left (painful side)

Keys to Examining Elbows  1) Radial Head points to Capitellum on all views Fat Pads are your Friend Adults = Radial Head Fracture Children = Supracondylar Fx (Lateral Condyle Fx) Anterior Humeral Line Should pass thru middle ⅓ Capitellum When in doubt, get the other side 2) 3) 4)