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ONLINE LESSON 1:

ONLINE LESSON 1:
IDENTIFYING RADIAL HEAD FRACTURES
By: Dr. Kenneth Fortgang

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  • Type I: less than 2 mm displacement Type II: Angulation or >2 mm displacement Type III: comminuted
  • Figure 1. Lateral radiograph shows a positive fat pad sign in a patient with a nondisplaced fracture of the radial head. The anterior lucency (arrow) represents the elevated anterior fat pad, and the posterior lucency (arrowhead) represents the elevated posterior fat pad.

Premier radiologypresentation1 Premier radiologypresentation1 Presentation Transcript

  • ONLINE LESSON 1: IDENTIFYING RADIAL HEAD FRACTURES By: Dr. Kenneth Fortgang
  • KENNETH C. FORTGANG, MD
    • MEDICAL COLLEGE OF GEORGIA; MD
    • UNIV OF SOUTHERN CAL/LAC; SURGICAL INTERNSHIP
    • USC/LACOUNTY; RADIOLOGY RESIDENCY AND INTERVENTIONAL FELLOWSHIP
    • NORTH BROWARD HOSPITAL DISTRICT; LEVEL I AND LEVEL II TRAUMA CENTERS
  • RADIAL HEAD FRACTURES Kenneth C. Fortgang, MD Medical Director Premier Radiology Services
  • ELBOW ANATOMY
  • X-RAY ANATOMY
  • X-RAY ANATOMY
  • U L N A R A D I U S TROC CAP H U M E R U S Anatomy ©Ken L Schreibman, PhD/MD 2003
  • H U M E R U S U L N A TROC OLECRANON CORONOID Anatomy ©Ken L Schreibman, PhD/MD 2003 R A D I U S CAP
  • Fat Pads H U M E R U S CAP Anterior Fad Pad (Coronoid Fossa) Posterior Fad Pad (Olecranon Fossa) ©Ken L Schreibman, PhD/MD 2003 U L N A R A D I U S
  • NORMAL, NO EFFUSION
  • CAN YOU SEE THE FRACTURE?
  • CAN YOU SEE THE FRACTURE?
  • Systematic Approach to Musculoskeltal Radiographs
    • Adequate Exposure
    • Alignment
    • Bone Contour
    • Margins
    • Density
    • Tabecular pattern
    • Soft tissues
  • ELBOW FRACTURES
    • Ask for 3 views: AP, oblique extended, lateral 90 degree flexion.
    • Look for sail sign and posterior fat pad
    • If these signs are present but no fracture is identified, radial head fracture is likely.
    • Look for a fracture line and contour deformity
  • Radiographic Signs of Radial head fracture on Lateral view
  • Radial head fracture types
    • Type I: less than 2 mm displacement
    • Type II: angulated or >2 mm displaced
    • Type III: comminuted
  • RADIAL HEAD FRACTURE WITH FAT PADS
  • Anterior and Posterior Fat Pad
  • Figure 1. Lateral radiograph shows a positive fat pad sign in a patient with a nondisplaced fracture of the radial head. Goswami G K Radiology 2002;222:419-420 ©2002 by Radiological Society of North America
  • FAT PAD=RADIAL HEAD FX
    • Radial neck fracture
    • Extra-capsular
    • No FAT PAD
  • FAT PADS
  • SAGITTAL EFFUSION
  • CT FRACTURE AND EFFUSION
  • EFFUSION
  •  
  • RADIAL NECK FRACTURE AND MINIMAL EFFUSION
  • RADIAL HEAD FRACTURE WITH EFFUSION
  • MRI EFFUSION TAKE THIS HOME
  • Conclusion: elbow trauma radiograph evaluation
    • Look for fat pads signs (capsular effusion)
      • Anterior fat pad (from coronoid fossa) may be normal; compare to other side
      • Posterior fat pad (from olecranon fossa) is always abnormal
    • Compare to x-rays of other side in children
    • If elbow can’t be extended, obtain AP/lat of both humerus and forearm
  • PREMIER RADIOLOGY SERVICES