1 / 18

Elbow Trauma

Elbow Trauma. Elbow Trauma. 6% of all fractures and dislocations involve elbow Most common fractures differ between adults and children M.C. in adults- radial head and neck fxs. M.C. in children- supracondylar fxs. Complex anatomy requires 4 views for adequate interpretation

stash
Télécharger la présentation

Elbow Trauma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Elbow Trauma

  2. Elbow Trauma • 6% of all fractures and dislocations involve elbow • Most common fractures differ between adults and children • M.C. in adults- radial head and neck fxs. • M.C. in children- supracondylar fxs. • Complex anatomy requires 4 views for adequate interpretation • AP in extension, medial oblique, lateral and axial olecranon (Jones view)

  3. Normal Elbow Anatomy • Very important to be aware of pediatric growth centers • CRITOE http://www.radiologyassistant.nl/en/4214416a75d87 http://med_practice.byethost7.com/wp2/?p=21

  4. Normal Alignment • Anterior humeral line- line drawn along anterior surface of humeral cortex should pass through the middle third of the capitellum • Radiocapitellar line- Line drawn through the proximal radial shaft and neck should pass through to the articulating capitellum http://imageinterpretation.co.uk/elbow.html

  5. Signs of Fracture • Usual signs may not be readily visible • Fracture line, cortical disruption, etc. • Soft tissue signs can indicate fracture • Fat pad sign • On lateral, might see fat pad parallel to anterior humeral cortex, but should never see posterior fat pad • With effusion, anterior may be displaced and will be shaped like a sail (sail sign)

  6. Fat Pad Sign • Posterior fat pad is normally buried in olecranon fossa and not visible • Becomes elevated and visible with joint uffusion • Effusion (acute capsular swelling) can be from any origin (hemorrhagic, inflammatory, infectious, traumatic, etc.) • Ant. fat pad may be obliterated, so post. Fat pad is more reliable when visible

  7. Distal humerus fractures • 95% extend to articular surface • Classified according to relationship with condyle and shape of fracture line • Supracondylar, intercondylar, condylar and epicondylar

  8. Supracondylar Fractures • Most common elbow fracture in children (60%) • Fracture line extends transversely or obliquely through distal humerus above the condyles • Distal fragment usually displaces posteriorly Normal

  9. Intercondylar fracture • Fracture line extends between medial and lateral condyles and extends to supracondylar region • Results and T or Y shaped configuration for fracture • Called trans-condylar if it extends through both condyles

  10. Epicondylar fracture • Usually avulsion from traction of respective common flexor (medial) or extensor (lateral) tendons • Medial epicondyle avulsion common in sports with strong throwing motion (little leaguer’s elbow)

  11. Fractures of Proximal Ulna • Olecranon fx.- direct trauma or avulsion by triceps tendon • Coronoid process fx.- avulsion by brachialis or impaction into trochlear fossa • Rarely isolated; usually associated with post. elbow dislocation

  12. Fractures of Proximal Radius • M.C. adult elbow fx. (50%) • FOOSH transmits force causing impaction of radial head into capitellum • Chisel fracture- incomplete fracture of radial head that extends to center of articular surface • Usual rad. signs (fx. Line, articular disruption) may not be visible • May be occult; fat pad sign is good indicator of occult fx.

  13. Fractures of the forearm • Isolated ulnar fractures • Isolated radial fractures • Bony rings usually can't be fractured in one place without disruption somewhere else in the ring • 60% or forearm fractures involve both bones (BB fractures) • These fractures usually have associated displacement with angulation and rotation

  14. Isolated Ulnar Fractures • Distal shaft (Nightstick fx.)- direct trauma • Proximal shaft (Monteggia’s fx.)- fx. of proximal ulna with dislocation of radius http://radiographics.rsna.org/content/24/4/1009/F31.expansion.html http://www.wheelessonline.com/ortho/monteggias_fracture

  15. Isolated Radial Fractures • Most frequent is a Galeazzi’s fx. (reverse Monteggia’s fx.) • Fracture of distal radial shaft with dislocation of distal radioulnar joint • Rare, but serious injury http://www.learningradiology.com/archives05/COW%20157-Galeazzi%20Fx/galeazzicorrect.htm

  16. Dislocations of Elbow • 3rd m.c. dislocation in adults behind shoulder and interphalangeal joints • More common in children • Classified according to displacement of radius an ulna relative to humerus • Posterior, posterolateral, anterior, medial and anteromedial • Posterior and posterolateral or more most common • 85-90% of all elbow locations • 50% have associated fractures

  17. Pulled Elbow • AKA nursemaid’s elbow • Occurs when child’s hand is pulled, tractioning arm and causing radial head to slip out from under annular ligament and trapping the ligament in the radiohumeral articulation • Immediate pain; stuck in mid-pronation due to pain • No radiographic pain • Supination reduces the dislocation and ends pain, usually during positioning of lateral radiograph

  18. References Yochum, T.R. (2005) Yochum and Rowe’s Essentials of Skeletal Radiology, Third Edition. Lippincott, Williams and Wilkins: Baltimore.

More Related