System for Reading Pediatric Elbow Xrays

• Verify patient name and side

• Quality of views

• Follow cortices and medullary canals proximal to distal humerus, ulna, then radius

• Anterior humeral line

• Radiocapitellar line

• Assess joint line for varus valgus

• Assess Physes

• Soft tissue shadows

• Look closely at point of maximal tenderness (based off your physical exam)

Assessing quality of elbow xrays:

 

• The true lateral elbow has a minimal AP dimension.

• Semi-circular surfaces of condyles aligned.

• Space visible across ulnohumeral joint

 

Anterior humeral line:

• Should cross middle third of capitellum, if it doesn’t the lateral view is off or that a fracture is likely

 

Radiocapitellar line (aka. Proximal radial line)

• Line should bisect the capitellum into halves (if it doesn’t that means radial head dislocation)

• The proximal radial line should always bisect the capitellum in any projection

Varus valgus of elbow:

 

 

• Varus means the distal segment is going towards midline

• Valgus means the distal segment is going away from midline

• The above picture shows the carrying angle (Cubitus angle)

  • If it is inferior to 5 degrees : Cubitus varus

  • And when it is superior to 15 degrees: Cubitus valgus

 

Physes in pediatric elbow:

 

 

Soft tissue shadows:

 

 

• Fat pad sign does not equal fracture, it indicates increased chance of fracture

• Anterior fat pad: Probability is 70-80% for intra-articular fracture

• Posterior fat pad: Probability is 90% for intra-articular fracture

Example Case

Image reference: Twitter @davembmd

 

• Practice with the image above! Check the comments for the answer!

• Does anyone know what the image is showing?

 

References:

Twitter @davembmd

http://www.wikiradiography.net/page/The+Paediatric+Elbow

https://radiopaedia.org/cases/normal-elbow-carrying-angle

https://www.orthobullets.com/pediatrics/4008/medial-epicondylar-fractures–pediatric