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WWWTP #16 Answer…

May 22, 2014

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Several days ago I asked What’s Wrong With This Picture (WWWTP #16):

Elbow fx 3Elbow fx 2Elbow fx 1

Here’s what radiology thought:

1.  There is a fracture of the lateral epicondyle with displacement.

2.  There is subluxation of the capitellum anteriorly.

3.  There is a minimally displaced fracture of the olecranon process.

4.  There is a large amount of soft tissue swelling adjacent to the elbow, most pronounced laterally.

5.  Exam is somewhat limited due to lack of true lateral radiograph.

 

#1 is fairly easily identified on all 3 radiographs.  #2 is readily apparent if you apply the anterior humeral line to the radiograph, see link below for further details.  #3 can be best identified by the lucent line on the latter two radiographs.  #4 is apparent also on the second two radiographs.  #5 is a true statement, it is not a great lateral radiograph.  However, can you imagine the difficulty the radiology tech had trying to get anatomic landmarks when it is this swollen?

Hopefully you got all the findings!

Here is a brief review of the anterior humeral line of the elbow from radiopaedia.org:

Anterior Humeral Line

Author:  Russell Jones, MD

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Supracondylar fracture…

November 8, 2013

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Child came in with elbow pain after a fall:

SC Fx II 2 SC Fx II

This child has a Gartland Type II supracondylar fracture of the distal humerus.  On the film of the normal, asymptomatic right elbow if you draw an anterior humeral line it goes directly through the capitellum.  This is not true for the left film and demonstrates posterior displacement of the capitellum with an intact posterior cortex of the distal humerus.  The injured elbow also demonstrates and anterior and posterior fat pad sign.

Gartland classification of supracondylar elbow fractures:

Type I:  Nondisplaced

Type II: Mild posterior displacement with intact posterior cortex

Type III: Completely displaced

Author:  Russell Jones, MD

Image Contributor:  Ali Naqvi, MD

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Football injury…

November 4, 2012

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I was working peds last night and an 8-year-old male came in with elbow pain after falling on an outstretched hand while playing football.  Another player fell on his elbow at the same time.  He had an obvious deformity and his elbow film is classic for an eponym fracture:

This is a Monteggia fracture-dislocation.  It involves a fracture of the proximal ulna and dislocation of the radial head.

Giovanni Monteggia (1814) originally described this fracture pattern.  It is usually associated with a direct blow or a hyperpronation, extension mechanism.  In this radiograph the radial head dislocation is obvious, however sometimes it can be subtle and missed.  Always draw a line through the radial head and make sure it intersects the capitellum on both the AP and lateral views (radiocapitellar line).  Here is an example of a normal radiocapitellar line:

 

Author:  Russell Jones, MD

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