Pediatric Elbow Injuries - Elbow Xrays
Check the fat pads on the lateral projection:
1. A displaced anterior fat pad (sail sign) is abnormal
2. A visible posterior fat pad is always abnormal
3. Not all joint effusions are associated with fractures.
4. An effusion often suggests that a significant injury has occurred. This is irrespective of if a fracture can be seen or not.
Check the anterior humeral line on the lateral projection:
1. A line traced along the anterior cortex of the humerus should have at least one third of the capitellum anterior to it.
2. If less than one third of the capitellum lies anterior to this line, there is a strong probability of a supracondylar fracture with the distal fragment (including the capitellum) displaced posteriorly.
Check the radiocapitellar line on the lateral projection:
1. A line drawn along the longitudinal axis of the radial head and neck should pass through the capitellum. If it does not through the capitellum pass through the capitellum: a radial head dislocation is likely.
2. The normal radius frequently shows a bend or slight angulation in the region of its tuberosity. Draw the RC line along the long axis of the proximal 2-3 cm of the radius. Not along the long central axis of the shaft of the radius.
Dr. Sarah Edwards @drsarahedwards
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