elbow trauma

©Ken L Schreibman, PhD/MD 2010 schreibman.info

Elbow Trauma Anatomy

3D Dislocations

Radial Head Fractures

Radial HeadForearm

PatternsChildren

Examining Elbow Radiographsschreibman.info


Elbow Anatomy


Elbow AnatomyCapitellum[L. small head] ball-shaped

Trochlea[Gr. pulley] spool-shaped

Radial Head disc-shaped

Olecranon[Gr. elbow]

ULNA

RADIUS

TROC CAP

HUMERUS

HEADOLEC


Elbow Anatomy


Elbow Anatomy HUMERUS

RADIUS

CAP

ULNA

TROC

OLECRANON

CORONOIDON

CORACOID



RADIUS

CAP

ULNA

TROC

OLECRANON

CORONOIDON

CORONOID


Elbow Dislocations

LateralView

Olecranon & Radial HeadEasy!

APView

APView

Relocated


Elbow Dislocations: Parallelism

APView

Relocated

APView

Dislocated

ParallelArticularSurfaces


Lack ofParallelism

Lack ofParallelism

LateralView

Relocated ParallelArticularSurfaces



Elbow DislocationsOlecranon & Radial HeadEasy!

Radial Head OnlyCan be very subtle


Keys to Examining ElbowsRadial Head points to Capitellumon all views

1)

2)

3)

4)



RADIUS

CAP

ULNA

TROC



RADIUS

CAPTROCRadial Headpoints to

Capitellum

Radial Headpoints to

Capitellum


Elbow Anatomy


Capitellum


Capitellum


AP LateralCongenital Radial Head Dislocation4 year-old maleNo traumaCould not

supinate arm

Lateral

RightLeft


Elbow DislocationsOlecranon & Radial HeadEasy!

Radial Head OnlyCan be very subtle


10 year-old femaleAP Lateral--------- Not a True Lateral

True Lateral

Monteggia Fracture


Monteggia Fracture

ULNA

HUMERUSCAP

TROC

CARPUS

FALL

RADIUS


Monteggia Fracture

HUMERUS

ULNA

CAP

TROC

CARPUS

FALL

RADIUS


Monteggia FracturePost Reduction


Monteggia FractureGiovanni Battista Monteggia (1762-1815)Greatest Italian Surgeon

beginning 19th century

Hunter, Peltier, LundRadioGraphics2000:20;819-836

Fx Prox 1/3 UlnaAnt Disloc Rad Head


Monteggia Fracture

Bado’s classification of Monteggia fractures



Monteggia Fracture


Forearm Fractures

ULNA

HUMERUSCAP

TROC

CARPUS

FALL

RADIUS


Forearm Fractures

ULNA

HUMERUSCAP

TROC

CARPUS

FALL

RADIUS

: Galeazzi: Galeazzi


Riccardo Galeazzi (1866-1952) Developed Orthopedic Rehab in ItalyCrippled soldiers/children wounded WWI

Galeazzi Fracture


Fracture Middle-Distal ⅓ RadiusDislocation of the Distal Radio-Ulnar Joint (DRUJ)


Galeazzi Fracture << Monteggia

Fracture Middle-Distal ⅓ RadiusDislocation of the Distal Radio-Ulnar Joint (DRUJ)


Monteggia vs Galeazzi: mnemonic

HUMERUS

ULNA

CAP

TROC

CARPUS

FALL

RADIUS

ULNA

HUMERUSCAP

TROC

CARPUS

FALL

RADIUS

MU/GRM GU R


Forearm Fractures

ULNA

HUMERUSCAP

TROC

CARPUS

RADIUS

: Nightstick Fx: Nightstick Fx


Forearm Fractures: Nightstick Fx: Nightstick FxChicago, 1968


Forearm Fractures

2 months later

: Nightstick Fx: Nightstick Fx


Both Bone Forearm Fracture

ULNA

HUMERUSCAP

TROC

CARPUS

FALL

RADIUS

Common in childrenCan look scary…

…but should heal well “if both ends of the bone are in the same room”


Both Bone Forearm FractureAP View7 Months Later

Lateral View

12 year-old Male


Essex-Lopresti Fracture

IOMULNA

HUMERUSCAP

TROC

CARPUS

FALL

RADIUS


Essex-Lopresti FracturePeter Gordon Essex-Lopresti (1918-1951)British Surgeon, Air Borne Div, WWIIExpert on Parachuting InjuriesClassification scheme for Calcaneal Fxs

Radial Head Fx w/ Disruption DRUJ Displaced Rad Head Fx Examine Wrist Closely




Impacted, ComminutedRadial Head Fracture


Lack ofParallelism

Lack ofParallelism





Radial HeadProsthesis



Lack ofParallelism

Lack ofParallelism

Parallel articular surfaces

Parallel articular surfaces

PostRadial HeadProsthesis


Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your Friend

1)

2)

3)

4)


Elbow Fat PadsHUMERUS

ULNA

CAP

RADIUS


Elbow Fat Pads

U L N AR A D I U S

HUMERUS

Anterior Fad Pad(Coronoid Fossa)Posterior Fad Pad

(Olecranon Fossa)

Resnickfig22-15

With a radial head fracture:Bleeding into joint

(hemarthrosis)Elevates the Fat Pads

CAP

Resnick fig22-16


Elbow Fat Pads

U L N AR A D I U S

HUMERUS

CAP

Normally, can’t see Posterior Fat Pad(tucked in olecranon fossa)

Anytime youcan see it,indicates it is displaced…probably by hemarthrosis


Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your FriendMost Radial Head Fractures are non-displaced and hard to seeAdults = Radial Head Fracture

1)

2)

3)

4)


Elevated Fat Pad = Radial Head Fx

U L N AR A D I U S

HUMERUS

CAP

Lateral

APOblique


Elevated Fat Pad = Radial Head Fx

EXTROT


Radial Neck is Outside Joint Capsule

Resnickfig22-15

Radial Neck fracturedoes not cause a hemarthrosis, anddoes not elevate the fat pads.


Radial Neck is Outside Joint Capsule

Resnickfig22-15

No Fat PadElevation


Keys to Examining ElbowsRadial Head points to Capitellumon all viewsFat Pads are your FriendAdults = Radial Head FractureChildren = Supracondylar Fx

1)

2)

3)

4)


Anatomy

ULNA

RADIUS

HUMERUS

TROC CAP


Anatomy

ULNA

RADIUS

HUMERUS

Articular surfaces unossified at birthOssify in orderC R I T O ECapitellumRad HeadInt (med) EpiTrochleaOlecranonExt (lat) Epi

: Ossification Centers: Ossification Centers

CAP

2 year-old female

…..2

…..4..6

…….8…

10

..12


Elbow Fractures: Children

ULNA

RADIUS

HUMERUS

CAP

Supracondylar Fracture 60% Elbow Fxs in

Children SubtleGrossly

Displaced



ULNA

RADIUS

HUMERUS

CAP

2 year-old female



Displaced

Right (painful side) Left (normal side)


Elbow Fractures: ChildrenSupracondylar Fracture 60% Elbow Fxs in


Displaced



Displaced



Supracondylar Fracture


AnteriorHumeral

LineShould passthru middleCapitellum



Anterior Humeral LineShould pass thru middle ⅓

Capitellum

1)

2)

3)

4)


Supracondylar Fracture

5 year-old female

Day of injury After 2 weeks After 5 weeks



(Lateral Condyle Fx)Anterior Humeral LineShould pass thru middle ⅓

Capitellum

1)

2)

3)

4)


Elbow Fractures: ChildrenLateral Condyle Fracture2nd most common pediatric elbow Fx20% of elbow injuries in children


6 year-old female

Elbow Fractures: ChildrenLateral Condyle Fracture2nd most common pediatric elbow Fx20% of elbow injuries in children

Left (painful side)Right (normal side)




CapitellumWhen in doubt, get the other side

1)

2)

3)

4)



C R I T O ECapitellumRad HeadInt (med) EpiTrochleaOlecranonExt (lat) Epi

…..2

…..4..6

…….8…

10

..12

CI

RT

O

E

14 year-old male



14 year-old male

Left (painful side)Right (normal side)

Width of normalgrowth plate

Abnormallywidenedgrowthplate

Abnormallywidenedgrowthplate

Avulsion Medial Epicondyle“Little Leaguer’s Elbow”Traction common

tendon flexor-pronator group

Traction UCLResult of

valgus stressFall on out-

stretched handViolent

throwingcontractions




CapitellumWhen in doubt, get the other side

1)

2)

3)

4)

elbow trauma

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