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Elbow radiographs obtained after trauma should evaluate for fracture and dislocation.

Traumatic Elbow 1

Examine the radiocapitellar and ulnotrochlear articulations. The following are helpful to assess for traumatic malalignment:

 

 

  • Radiocapitellar line
    • Drawn through center of radius long axis, should pass through the mid capitellum on all projections

 

 

 

 

  • Anterior humeral line
    • Drawn along anterior surface of humerus, should pass through mid capitellum on lateral view
Traumatic Elbow 2

Examine anterior and posterior fat pads to look for signs of  effusion.

Convex displacement of anterior and/or posterior fat pads suggests traumatic effusion. If no fracture identified, it is appropriate to raise possibility occult fracture to recommend follow up imaging.

Traumatic Elbow 3

Scrutinize the radial head and neck.

If fractured, describe the degree of displacement, estimated amount of articular surface involved, and presence of comminution.

FINDINGS:

  • Mildly displaced radial head fracture involving approximately 30 percent of the articular surface with at least 1-2 mm articular surface offset, best demonstrated on oblique projection.
Traumatic Elbow 4

Example report negative for traumatic injury:

 

FINDINGS:

  • No acute fracture. Elbow alignment is intact. No effusion.

 

IMPRESSION:

  • No acute fracture or traumatic malalignment

 

Traumatic Elbow Injuries: What the Orthopedic Surgeon Wants to Know. Scott E. Sheehan, George S. Dyer, Aaron D. , Ketankumar I. Patel, and Bharti Khurana.  2013 33:3, 869-888