After completion of this session, students should be able to discuss, identify, and describe: The anatomical factors predisposing to the etiology of a fracture or dislocation. The anatomy of displacement or deformity. Imaging anatomy features and how to differentiate from epiphyseal lines. Anatomy related to correct relocation and alignment. Anatomical complications of a fracture or dislocation.

1. Dr.AkramJaffar
Imaging Anatomy of Fractures and Dislocations inImaging Anatomy of Fractures and Dislocations in
the Upper Limbthe Upper Limb
Subluxation of the head of the radius:Subluxation of the head of the radius:
pulled elbowpulled elbow
Akram Jaffar, Ph.D.
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2. Dr.AkramJaffar
References and suggested reading
• Ellis H (2006): Clinical anatomy, A revision and applied anatomy for clinical students.
11th
Ed. Blackwell Publishing. Massachusetts.
• Moore KL et al. (2013): Clinically Orientated Anatomy. 7th Ed. Lippincott, Williams &
Wilkins. Philadelphia.
• Hamblen DL & Simpson HRW (2007): Adam’s outline of fractures including joint
injuries. 12th
ed. Churchill Livingstone Elsevier. Edinburgh.
• Solomon L, Warwick DJ & Nayagam S (2001): Apley's System of Orthopedics and
Fractures. 8th ed. Arnold Publishing.

3. Dr.AkramJaffar
Objectives
After completion of this session, students should be able to discuss, identify, and describe:
• The anatomical factors predisposing to the etiology of a fracture or dislocation.
• The anatomy of displacement or deformity.
• Imaging anatomy features and how to differentiate from epiphyseal lines.
• Anatomy related to correct relocation and alignment.
• Anatomical complications of a fracture or dislocation.

4. Dr.AkramJaffar
Anterior humeral and radiocapetellar lines
• Radiographic anatomy:
• The anterior humeral line should intersect the
middle third of the capitulum on the lateral view.
Failure indicates supracondylar fracture.
• Radio capetellar line drawn through the middle
of the radius should bisect the capitulum.
Failure to align properly indicates a radial head
dislocation.
olecranon
capitulum

5. Dr.AkramJaffar
Anterior humeral and radiocapetellar lines
Supracondylar fracture
A radial head dislocation with an
olecranon fracture (Monteggia injury)
capitulum
capitulum

6. Dr.AkramJaffar
Humerus lower end ossification centres
• Four centres appear
– Capitulum at the 2nd
year
– Medial epicondyle
– Trochlea by the 12th
year
– Lateral epicondyle by the 13th
year
3 years
5 years
capitulum
capitulum
Medial
epicondyle
radius
ulna
radius
ulna
humerus
humerus
lateral
epicondyle
trochlea

7. Dr.AkramJaffar
Humerus lower end ossification centres
• The ossification centers blend with each
other at puberty
• Blend with the shaft at 14-16 years
• The medial epicondyle unites with the shaft
at 20 years
The four centers are present
Medial
epicondyle
Medial
epicondyle
radius ulna
lateral
epicondyle
radius ulna
capitulum
trochlea
humerus
humerus

8. Dr.AkramJaffar
Ulna and radius ossification
• Ulna:
– Head (6th
year), fuses at 20 years
– Olecranon (8th
year), fuses at 18
• Radius:
– Lower end (2nd
year), fuses at 20
– Head (4th
year), fuses at 18
11years 11years
radius
ulna
Radial head
ulnar head

9. Dr.AkramJaffar
• The annular ligament is funnel-shaped in adults,
but its sides are vertical in children.
• Sudden pull on the pronated forearm of a child
results in incomplete dislocation of the head of
the radius
• Part of the annular ligament becomes trapped
between the radial head and the capitulum.
• Reduction is affected by firm supination of the
elbow to return the radial head back into place.
Subuxation of the head of the radius “Pulled elbow”
Annular lig.
capitulum
Radial
head
supination

10. Dr.AkramJaffar
• The annular ligament is funnel-shaped in adults,
but its sides are vertical in children.
• Sudden pull on the pronated forearm of a child
results in incomplete dislocation of the head of
the radius
• Part of the annular ligament becomes trapped
between the radial head and the capitulum.
• Reduction is affected by firm supination of the
elbow to return the radial head back into place.
Subuxation of the head of the radius “Pulled elbow”
Annular lig.
capitulum
Radial
head
supination