Pediatric Elbow - Examination and X-rays

The Child’s Elbow C. Noel Henley, MD http://www.noelhenley.com

Acute Injury http://www.noelhenley.com

Acute Injury• Primary goals of initial evaluation of acute injury http://www.noelhenley.com

Acute Injury• Primary goals of initial evaluation of acute injury - assess neurovascular status http://www.noelhenley.com

Acute Injury• Primary goals of initial evaluation of acute injury - assess neurovascular status - determine urgency of reduction http://www.noelhenley.com

Radiographic Anatomy http://www.noelhenley.com

Radiographic Anatomy• Centers of secondary ossiﬁcation http://www.noelhenley.com

Radiographic Anatomy• Centers of secondary ossiﬁcation - predictable order http://www.noelhenley.com

http://www.noelhenley.com

Radiographic Anatomy• Multiple ossiﬁcation centers may be mistaken for a fracture http://www.noelhenley.com

Radiographic Anatomy• Multiple ossiﬁcation centers may be mistaken for a fracture• Radiographs of the opposite elbow may help http://www.noelhenley.com

Radiographic Anatomy• Relationships to look for http://www.noelhenley.com

Radiographic Anatomy• Relationships to look for - capitellum should always line up with radial head - if not... http://www.noelhenley.com

Radiographic Anatomy• Relationships to look for - capitellum should always line up with radial head - if not... • lateral condyle fracture http://www.noelhenley.com

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

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

Radiographic Anatomy• Relationships to look for http://www.noelhenley.com

Radiographic Anatomy• Relationships to look for - anterior humeral line http://www.noelhenley.com

Radiographic Anatomy• Relationships to look for - anterior humeral line • should bisect the capitellum on a lateral radiograph - if not... http://www.noelhenley.com

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

Examination http://www.noelhenley.com

Examination• Tips on examining the painful child http://www.noelhenley.com

Examination• Tips on examining the painful child - observation http://www.noelhenley.com

Examination• Tips on examining the painful child - observation • arm/elbow held close? http://www.noelhenley.com

Examination• Tips on examining the painful child - observation • arm/elbow held close? • elbow ﬂexed/extended/pronated? http://www.noelhenley.com

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

Examination http://www.noelhenley.com

Examination• Tips on examining the painful child http://www.noelhenley.com

Examination• Tips on examining the painful child - palpation (joint above, joint below, too) http://www.noelhenley.com

Examination• Tips on examining the painful child - palpation (joint above, joint below, too) • start with other side http://www.noelhenley.com

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

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

Thanks! Find out more athttp://www.noelhenley.com www.noelhenley.com

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Pediatric Elbow - Examination and X-rays

by C Noel Henley MD on Feb 28, 2011

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Pediatric Elbow - Examination and X-rays — Presentation Transcript