Elbow radiographs obtained after trauma should evaluate for fracture and dislocation.
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
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.
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.
Example report negative for traumatic injury:
FINDINGS:
- No acute fracture. Elbow alignment is intact. No effusion.
IMPRESSION:
- No acute fracture or traumatic malalignment