System for Reading Pediatric Elbow Xrays

System for Reading Pediatric Elbow Xrays

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:

 

Ossification center (bone is added to cartilage scaffold) – CRITOE is an important acronym

Age at ossification (appears on xrays) – goes up by odd numbers, +/- 1 year between boys/girls

Capitellum

1

Radius

3

Internal (medial) epicondyle

5

Trochlea

7

Olecranon

9

External (lateral) epicondyle

11

 

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

 

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