This document provides information on evaluating the elbow on x-ray, including normal anatomy, common injuries, and signs to look for. It discusses the fat pad sign seen with joint effusion, anatomical lines used to evaluate fractures and dislocations, common elbow fractures in adults and children, and positioning for optimal elbow x-rays. Key points covered include the anterior humeral line and radiocapitellar line, supracondylar fractures, radial head fractures, elbow dislocations, and using the fat pad sign to detect subtle injuries.

1. CAN I OFFER MORE SIM KIAN TZE JURU X-RAY SARAWAK GENERAL HOSPITAL UPDATE FOR RADIOGRAPHER

3. FAT PAD SIGN

5. Fat Pad Sign and Joint effusion Positive fat pad sign Distention of the joint will cause the anterior fat pad to become elevated and the posterior fat pad to become visible. An elevated anterior lucency and/or a visible posterior lucency on a true lateral radiograph of an elbow flexed at 90° is described as a positive fat pad sign

7. FAT PAD SIGN

8. FAT PAD SIGN

9. FAT PAD SIGN

10. TWO (2) LINES

11. ANTERIOR HUMERAL LINE PROXIMAL RADIAL/RADIOCAPITELLAR LINE

13. Supracondylar fractures A : The anterior humeral line passes through the anterior third of the capitellum and in B even more anteriorly. Notice positive posterior fat pad sign in both cases

14. BACK TO BASIC

17. ELBOW AP MODIFIED

18. ELBOW AP MODIFIED

19. ELBOW AP MODIFIED

20. Common errors in positioning Shoulder higher than elbow For a true lateral view the shoulder should be at the level of the elbow. If the shoulder is higher than the elbow the radius and capitellum will project on the ulna. The solution is either to lift the examination table which will lift the elbow or to lower the shoulder by placing the patient on a smaller chair.

23. Common errors in positioning : Wrist lower than elbow The wrist should be as high or even higher than the elbow depending on the normal valgus position of the elbow. The hand should be with the 'thumb up'. If the wrist is at a low position the humerus will rotate because the radius at the level of the wrist is lower than at the level of the elbow.

26. Supracondylar fractures

27. Supracondylar fractures A : The anterior humeral line passes through the anterior third of the capitellum and in B even more anteriorly. Notice positive posterior fat pad sign in both cases

30. Fracture of the Radial head Left: both anterior and posterior fat pad signs are present. This should increase suspicion of a fracture. However, no fracture is apparent in this radiograph. Right: A different view taken from the same patient. In this view the radial head fracture is apparent.

32. Fracture of the Radial head AP and Lat views of elbow: markedly communited and displaced fracture of radial head.

33. Fracture of the Radial head

35. Dislocations of the Radial head LEFT: an obvious radial dislocation. No fracture of the ulna (Monteggia) was found RIGHT: a subtle radial head dislocation. Associated olecranon fracture is seen on carefull inspection

38. Fracture radial head DO YOU SEE ANY FRACTURE ?

39. NO FRACTURE ?

40. Repeat radiograph 2 weeks -Fracture epiphysis of radial head

41. Elbow dislocation

42. Fracture lateral condyle of Humerus

43. Fracture medial epicondyle of Humerus

44. Fracture radial head

45. Supracondylar fracture

46. conclusion conclusion

53. Fat Pad Sign and Joint effusion Positive fat pad sign Distention of the joint will cause the anterior fat pad to become elevated and the posterior fat pad to become visible. An elevated anterior lucency and/or a visible posterior lucency on a true lateral radiograph of an elbow flexed at 90° is described as a positive fat pad sign

54. FAT PAD SIGN

55. FAT PAD SIGN

56. FAT PAD SIGN

57. FAT PAD SIGN

58. MRI FAT PAD

59. THAT ALL FOR TODAY THANK YOU Diagrams and notes taken from kursus for trauma radiography Nov 2006-sept 2007 BY DR ZALEHA BT ABD MANAF