Pediatric Elbow - Examination and X-rays

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Get a quick overview of children's elbow injuries and how to examine the child with a painful elbow injury. Find out more about hand and arm problems at http://www.noelhenley.com.

Ozark Orthopaedic: Henley C Noel MD
3317 North Wimberly Drive, Fayetteville, AR 72703
(479) 521-2752

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  • - capitellum usually by 1yo\n- lateral condyle usually last (10yo)\n
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  • - capitellum and radial head line up on all views\n
  • - fat pad may be helpful but...\n- small anterior fat pad on lateral may be normal; posterior fat pad should not be visible (indicates an intra-articular injury 90% of the time)\n
  • - fat pad may be helpful but...\n- small anterior fat pad on lateral may be normal; posterior fat pad should not be visible (indicates an intra-articular injury 90% of the time)\n
  • - fat pad may be helpful but...\n- small anterior fat pad on lateral may be normal; posterior fat pad should not be visible (indicates an intra-articular injury 90% of the time)\n
  • - fat pad may be helpful but...\n- small anterior fat pad on lateral may be normal; posterior fat pad should not be visible (indicates an intra-articular injury 90% of the time)\n
  • - capitellum and radial head line up on all views\n
  • - capitellum and radial head line up on all views\n
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  • - tenderness often well-localized in elbow fractures. \n- radial neck fractures may be subtle (no fat pad [extra-capsular], xrays look OK)\n
  • - tenderness often well-localized in elbow fractures. \n- radial neck fractures may be subtle (no fat pad [extra-capsular], xrays look OK)\n
  • - tenderness often well-localized in elbow fractures. \n- radial neck fractures may be subtle (no fat pad [extra-capsular], xrays look OK)\n
  • - tenderness often well-localized in elbow fractures. \n- radial neck fractures may be subtle (no fat pad [extra-capsular], xrays look OK)\n
  • - tenderness often well-localized in elbow fractures. \n- radial neck fractures may be subtle (no fat pad [extra-capsular], xrays look OK)\n
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  • Pediatric Elbow - Examination and X-rays

    1. 1. The Child’s Elbow C. Noel Henley, MD http://www.noelhenley.com
    2. 2. Acute Injury http://www.noelhenley.com
    3. 3. Acute Injury• Primary goals of initial evaluation of acute injury http://www.noelhenley.com
    4. 4. Acute Injury• Primary goals of initial evaluation of acute injury - assess neurovascular status http://www.noelhenley.com
    5. 5. Acute Injury• Primary goals of initial evaluation of acute injury - assess neurovascular status - determine urgency of reduction http://www.noelhenley.com
    6. 6. Radiographic Anatomy http://www.noelhenley.com
    7. 7. Radiographic Anatomy• Centers of secondary ossification http://www.noelhenley.com
    8. 8. Radiographic Anatomy• Centers of secondary ossification - predictable order http://www.noelhenley.com
    9. 9. http://www.noelhenley.com
    10. 10. Radiographic Anatomy http://www.noelhenley.com
    11. 11. Radiographic Anatomy• Multiple ossification centers may be mistaken for a fracture http://www.noelhenley.com
    12. 12. Radiographic Anatomy• Multiple ossification centers may be mistaken for a fracture• Radiographs of the opposite elbow may help http://www.noelhenley.com
    13. 13. Radiographic Anatomy http://www.noelhenley.com
    14. 14. Radiographic Anatomy• Relationships to look for http://www.noelhenley.com
    15. 15. Radiographic Anatomy• Relationships to look for - capitellum should always line up with radial head - if not... http://www.noelhenley.com
    16. 16. Radiographic Anatomy• Relationships to look for - capitellum should always line up with radial head - if not... • lateral condyle fracture http://www.noelhenley.com
    17. 17. Radiographic Anatomy• Relationships to look for - capitellum should always line up with radial head - if not... • lateral condyle fracture • Monteggia fracture http://www.noelhenley.com
    18. 18. Radiographic Anatomy• Relationships to look for - capitellum should always line up with radial head - if not... • lateral condyle fracture • Monteggia fracture • elbow dislocation http://www.noelhenley.com
    19. 19. http://www.noelhenley.com
    20. 20. Radiographic Anatomy http://www.noelhenley.com
    21. 21. Radiographic Anatomy• Relationships to look for http://www.noelhenley.com
    22. 22. Radiographic Anatomy• Relationships to look for - anterior humeral line http://www.noelhenley.com
    23. 23. Radiographic Anatomy• Relationships to look for - anterior humeral line • should bisect the capitellum on a lateral radiograph - if not... http://www.noelhenley.com
    24. 24. Radiographic Anatomy• Relationships to look for - anterior humeral line • should bisect the capitellum on a lateral radiograph - if not... - suspect a supracondylar humerus fracture http://www.noelhenley.com
    25. 25. http://www.noelhenley.com
    26. 26. http://www.noelhenley.com
    27. 27. Examination http://www.noelhenley.com
    28. 28. Examination• Tips on examining the painful child http://www.noelhenley.com
    29. 29. Examination• Tips on examining the painful child - observation http://www.noelhenley.com
    30. 30. Examination• Tips on examining the painful child - observation • arm/elbow held close? http://www.noelhenley.com
    31. 31. Examination• Tips on examining the painful child - observation • arm/elbow held close? • elbow flexed/extended/pronated? http://www.noelhenley.com
    32. 32. Examination• Tips on examining the painful child - observation • arm/elbow held close? • elbow flexed/extended/pronated? • bruising, dimpling of skin (esp. anterior elbow)? http://www.noelhenley.com
    33. 33. Examination http://www.noelhenley.com
    34. 34. Examination• Tips on examining the painful child http://www.noelhenley.com
    35. 35. Examination• Tips on examining the painful child - palpation (joint above, joint below, too) http://www.noelhenley.com
    36. 36. Examination• Tips on examining the painful child - palpation (joint above, joint below, too) • start with other side http://www.noelhenley.com
    37. 37. Examination• Tips on examining the painful child - palpation (joint above, joint below, too) • start with other side • lateral, medial “bones” + olecranon process + radial head/neck http://www.noelhenley.com
    38. 38. Examination• Tips on examining the painful child - palpation (joint above, joint below, too) • start with other side • lateral, medial “bones” + olecranon process + radial head/neck • pain worse with pro/sup than with flex/ extension? http://www.noelhenley.com
    39. 39. Thanks! Find out more athttp://www.noelhenley.com www.noelhenley.com

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