Transcript Pediatric Elbow Radiology Heather Patterson

Pediatric
Elbow
Radiology
Heather Patterson
PGY-4
July 3, 2008
Outline and Objectives
•
Review of Anatomy
•
Review of Ossification Centres of the Elbow
•
Approach to the Pediatric Xray
•
Specific Fracture Patterns
•
Practice, Practice, Practice
Elbow Anatomy
Elbow Anatomy - Ossification
C = capitelum
2y
R = radial head
4y
I = medial epicondyle
6y
T = trochlea
8y
O = olecranon
10 y
E = lateral epicondyle
12 y
Elbow Anatomy - Ossification
Elbow Radiology
• Films:
– Lateral
• Most useful
• Soft tissues and bony anatomy
– AP
• Epicondyles
• Carrying angle (10°-12°)
• Articulations
– Oblique
• Not ordered consistently
• Can further evaluate condyles/epicondyles
Approach
1.
Adequacy of film
2.
Soft tissues and fat pads
3.
Alignment:
•
•
4.
Anterior humeral line
Radio-capitellar line
Bones:
•
•
•
•
Radial head
Radius
Ulna
Distal humerus
Adequacy of Film
•
Lateral:
–
–
Figure of 8
Elbow at 90 degrees
Soft tissues and fat pads
•
Anterior fat pad sign:
–
–
•
Presence is normal
Abnormal if triangular or sail
shaped
Posterior fat pad:
–
Always abnormal
Soft tissues and fat pads
Anterior Humeral line
•
Should bisect the capitellum
•
If capitellum displaced
posteriorly:
–
•
Extension supracondylar #
If capitellum displaced
anteriorly:
–
Flexion supracondylar #
Radio-capitellar line
•
Should bisect the capitellum
•
Can be used on any view
•
Disruption represents radial
head #/dislocation
Bones
•
Careful evalution of :
–
–
–
–
Radial head
Radius
Ulna and olecranon
Distal humerus
Fracture Types:
•
Supracondylar:
–
Extension vs Flexion
–
Gartland Types 1-3
Fracture Types:
•
Supracondylar:
–
Type 1
–
Type 2
–
Type 3
Fracture Types:
•
Supracondylar:
–
Type 1
–
Type 2
–
Type 3
Fracture Types:
•
Supracondylar:
–
Type 1
–
Type 2
–
Type 3
Fracture Types:
•
Radial head & neck
–
–
•
Type 1-3 based on angulation
>30 degrees, ORIF
Olecranon
–
–
–
5% of elbow injuries
Intra vs extraarticular
Displacement
Fracture Types:
•
Humeral
–
Transcondylar
–
Intercondylar
–
Condylar
–
Epicondylar
–
Articular surface
(trochlea/capitellum)
•
Ulnar
–
Coronoid
Case
Case
Case
Case
Case
Case
Case
Case
Case
Case
Case
Case
Case
Case
Case
Case
Case
Case
Case