ONLINE LESSON 1:  IDENTIFYING RADIAL HEAD FRACTURES By: Dr. Kenneth Fortgang
KENNETH C. FORTGANG, MD <ul><li>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 </li></ul>
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...
NORMAL, NO EFFUSION
CAN YOU SEE THE FRACTURE?
CAN YOU SEE THE FRACTURE?
Systematic Approach to Musculoskeltal Radiographs <ul><li>Adequate Exposure
Alignment
Bone Contour
Margins
Density
Tabecular pattern
Soft tissues </li></ul>
ELBOW FRACTURES <ul><li>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 </li></ul>
Radiographic Signs of Radial head fracture on Lateral view
Radial head fracture types <ul><li>Type I:  less than 2 mm displacement
Type II:  angulated or >2 mm displaced
Type III:  comminuted </li></ul>
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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 &gt;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

    1. 1. ONLINE LESSON 1: IDENTIFYING RADIAL HEAD FRACTURES By: Dr. Kenneth Fortgang
    2. 2. KENNETH C. FORTGANG, MD <ul><li>MEDICAL COLLEGE OF GEORGIA; MD
    3. 3. UNIV OF SOUTHERN CAL/LAC; SURGICAL INTERNSHIP
    4. 4. USC/LACOUNTY; RADIOLOGY RESIDENCY AND INTERVENTIONAL FELLOWSHIP
    5. 5. NORTH BROWARD HOSPITAL DISTRICT; LEVEL I AND LEVEL II TRAUMA CENTERS </li></ul>
    6. 6. RADIAL HEAD FRACTURES Kenneth C. Fortgang, MD Medical Director Premier Radiology Services
    7. 7. ELBOW ANATOMY
    8. 8. X-RAY ANATOMY
    9. 9. X-RAY ANATOMY
    10. 10. 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
    11. 11. 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
    12. 12. 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
    13. 13. NORMAL, NO EFFUSION
    14. 14. CAN YOU SEE THE FRACTURE?
    15. 15. CAN YOU SEE THE FRACTURE?
    16. 16. Systematic Approach to Musculoskeltal Radiographs <ul><li>Adequate Exposure
    17. 17. Alignment
    18. 18. Bone Contour
    19. 19. Margins
    20. 20. Density
    21. 21. Tabecular pattern
    22. 22. Soft tissues </li></ul>
    23. 23. ELBOW FRACTURES <ul><li>Ask for 3 views: AP, oblique extended, lateral 90 degree flexion.
    24. 24. Look for sail sign and posterior fat pad
    25. 25. If these signs are present but no fracture is identified, radial head fracture is likely.
    26. 26. Look for a fracture line and contour deformity </li></ul>
    27. 27. Radiographic Signs of Radial head fracture on Lateral view
    28. 28. Radial head fracture types <ul><li>Type I: less than 2 mm displacement
    29. 29. Type II: angulated or >2 mm displaced
    30. 30. Type III: comminuted </li></ul>
    31. 31. RADIAL HEAD FRACTURE WITH FAT PADS
    32. 32. Anterior and Posterior Fat Pad
    33. 33. 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
    34. 34. FAT PAD=RADIAL HEAD FX <ul><li>Radial neck fracture </li></ul><ul><li>Extra-capsular
    35. 35. No FAT PAD </li></ul>
    36. 36. FAT PADS
    37. 37. SAGITTAL EFFUSION
    38. 38. CT FRACTURE AND EFFUSION
    39. 39. EFFUSION
    40. 41. RADIAL NECK FRACTURE AND MINIMAL EFFUSION
    41. 42. RADIAL HEAD FRACTURE WITH EFFUSION
    42. 43. MRI EFFUSION TAKE THIS HOME
    43. 44. Conclusion: elbow trauma radiograph evaluation <ul><li>Look for fat pads signs (capsular effusion) </li></ul><ul><ul><li>Anterior fat pad (from coronoid fossa) may be normal; compare to other side
    44. 45. Posterior fat pad (from olecranon fossa) is always abnormal </li></ul><li>Compare to x-rays of other side in children
    45. 46. If elbow can’t be extended, obtain AP/lat of both humerus and forearm </li></ul>
    46. 47. PREMIER RADIOLOGY SERVICES

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