Step by Step Approach to Interpretation of Pediatric Elbow Radiography
Abstract
Trauma to the pediatric’s elbow are common and may result in different types of injuries such as bony, cartilaginous or soft tissue injuries. Fall on an outstretched hand is the most common mechanism of injury that mostly may result in hyperextension or valgus load to the elbow [1,2].
Comparing with adults, pediatric elbow fractures have a higher incidence and variability in fracture patterns [3]. 65 to 75% of all pediatric fractures are related to upper extremity. The most common is supracondylar humerus fracture followed by lateral condyle and medial epicondyle fractures [4].
Interpretation of pediatric elbow radiography needs a systematic approach to prevent misdiagnosis. In this study we explained a six-steps approach to an elbow radiography for better diagnosis of the injury.
The quality of radiography, identification of the presence and position of ossification centers, a search for effusion and localized soft tissue swelling, check the alignments, check the bone cortices and finally a focused search to avoid common mistakes based on the history and clinical examination of the patient are discussed in details.
References
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2. Jacoby SM, Herman MJ, Morrison WB, Osterman AL. Pediatric elbow trauma: An orthopaedic perspective on the importance of radiographic interpretation. Semin Musculoskelet Radiol. 2007;11(1):48-56. doi: 10.1055/s-2007-984412. [PubMed: 17665350].
3. Woods GW, Tullos HS. Elbow instability and medial epicondyle fractures. Am J Sports Med. 1977;5(1):23-30. doi: 10.1177/036354657700500105. [PubMed: 848632].
4. Rogers LF, Malave S Jr, White H, Tachdjian MO. Plastic bowing, torus and greenstick supracondylar fractures of the humerus: Radiographic clues to obscure fractures of the elbow in children. Radiology. 1978;128(1):145-50. doi: 10.1148/128.1.145. [PubMed: 663200].
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6. Crosby NE, Greenberg JA. Radiographic evaluation of the elbow. J Hand Surg Am. 2014;39(7):1408-14. doi: 10.1016/j.jhsa.2014.04.035. [PubMed: 24888528].
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16. Silva M, Pandarinath R, Farng E, Park S, Caneda C, Fong YJ, et al. Inter- and intra-observer reliability of the Baumann angle of the humerus in children with supracondylar humeral fractures. Int Orthop. 2010;34(4):553-7. doi: 10.1007/s00264-009-0787-0. [PubMed: 19424695]. [PubMed Central: PMC2903132].
17. Shank CF, Wiater BP, Pace JL, Jinguji TM, Schmale GA, Bittner RC, et al. The lateral capitellohumeral angle in normal children: Mean, variation, and reliability in comparison to Baumann's angle. J Pediatr Orthop. 2011;31(3):266-71. doi: 10.1097/BPO.0b013e31821009af. [PubMed: 21415685].
18. Simanovsky N, Lamdan R, Hiller N, Simanovsky N. The measurements and standardization of humerocondylar angle in children. J Pediatr Orthop. 2008;28(4):463-5. doi: 10.1097/BPO.0b013e31817445ff. [PubMed: 18520285].
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20. Silberstein MJ, Brodeur AE, Graviss ER, Luisiri A. Some vagaries of the olecranon. J Bone Joint Surg Am. 1981;63(5):722-5. [PubMed: 7240295].
21. Mhuircheartaigh JN, Lin YC, Wu JS. Bone tumor mimickers: A pictorial essay. Indian J Radiol Imaging. 2014;24(3):225-36. doi: 10.4103/0971-3026.137026. [PubMed: 25114385]. [PubMed Central: PMC4126137].
1. Manaster BJ, May DA, Disler DG. Musculoskeletal imaging: The
requisites. Philadelphia, PA: Elsevier Health Sciences; 2013.
2. Jacoby SM, Herman MJ, Morrison WB, Osterman AL. Pediatric elbow trauma: An orthopaedic perspective on the importance of radiographic interpretation. Semin Musculoskelet Radiol. 2007;11(1):48-56. doi: 10.1055/s-2007-984412. [PubMed: 17665350].
3. Woods GW, Tullos HS. Elbow instability and medial epicondyle fractures. Am J Sports Med. 1977;5(1):23-30. doi: 10.1177/036354657700500105. [PubMed: 848632].
4. Rogers LF, Malave S Jr, White H, Tachdjian MO. Plastic bowing, torus and greenstick supracondylar fractures of the humerus: Radiographic clues to obscure fractures of the elbow in children. Radiology. 1978;128(1):145-50. doi: 10.1148/128.1.145. [PubMed: 663200].
5. Chin TY, Chou H, Peh WCG. The acutely injured elbow. Radiol Clin North Am. 2019;57(5):911-30. doi: 10.1016/j.rcl.2019.03.006. [PubMed: 31351541].
6. Crosby NE, Greenberg JA. Radiographic evaluation of the elbow. J Hand Surg Am. 2014;39(7):1408-14. doi: 10.1016/j.jhsa.2014.04.035. [PubMed: 24888528].
7. Docherty MA, Schwab RA, Ma OJ. Can elbow extension be used as a test of clinically significant injury? South Med J. 2002;95(5): 539-41. [PubMed: 12005013].
8. Lennon RI, Riyat MS, Hilliam R, Anathkrishnan G, Alderson G. Can a normal range of elbow movement predict a normal elbow x ray? Emerg Med J. 2007;24(2):86-8. doi: 10.1136/emj.2006.039792. [PubMed: 17251609]. [PubMed Central: PMC2658213].
9. Lamprakis A, Vlasis K, Siampou E, Grammatikopoulos I, Lionis C. Can elbow-extension test be used as an alternative to radiographs in primary care? Eur J Gen Pract. 2007;13(4):221-4. doi: 10.1080/13814780701814820. [PubMed: 18324503].
10. Herman MJ, Boardman MJ, Hoover JR, Chafetz RS. Relationship of the anterior humeral line to the capitellar ossific nucleus: variability with age. J Bone Joint Surg Am. 2009;91(9):2188-93. doi: 10.2106/JBJS.H.01316. [PubMed: 19723996].
11. Atrey A, Nicolaou N, Katchburian M, Norman-Taylor F. A review of reported litigation against English health trusts for
the treatment of children in orthopaedics: Present trends and suggestions to reduce mistakes. J Child Orthop. 2010;4(5):471-6. doi: 10.1007/s11832-010-0276-4. [PubMed: 21966313]. [PubMed Central: PMC2946528].
12. Moraleda L, Valencia M, Barco R, Gonzalez-Moran G. Natural history of unreduced Gartland type-II supracondylar fractures of the humerus in children: A two to thirteen-year follow-up study. J Bone Joint Surg Am. 2013;95(1):28-34. doi: 10.2106/jbjs.l.00132. [PubMed: 23405411].
13. Jenkins FA Jr. The functional anatomy and evolution of the mammalian humero-ulnar articulation. Am J Anat. 1973;137(3): 281-97. doi: 10.1002/aja.1001370304. [PubMed: 4716355].
14. Storen G. Traumatic dislocation of the radial head as an isolated lesion in children; report of one case with special regard to roentgen diagnosis. Acta Chir Scand. 1959;116(2):144-7. [PubMed: 13626463].
15. Baumann E. Beitrage zur Kenntnis dur Frackturen am Ellbogengelenk. Bruns Beitr F Klin Chir. 1929;146:1-50.
16. Silva M, Pandarinath R, Farng E, Park S, Caneda C, Fong YJ, et al. Inter- and intra-observer reliability of the Baumann angle of the humerus in children with supracondylar humeral fractures. Int Orthop. 2010;34(4):553-7. doi: 10.1007/s00264-009-0787-0. [PubMed: 19424695]. [PubMed Central: PMC2903132].
17. Shank CF, Wiater BP, Pace JL, Jinguji TM, Schmale GA, Bittner RC, et al. The lateral capitellohumeral angle in normal children: Mean, variation, and reliability in comparison to Baumann's angle. J Pediatr Orthop. 2011;31(3):266-71. doi: 10.1097/BPO.0b013e31821009af. [PubMed: 21415685].
18. Simanovsky N, Lamdan R, Hiller N, Simanovsky N. The measurements and standardization of humerocondylar angle in children. J Pediatr Orthop. 2008;28(4):463-5. doi: 10.1097/BPO.0b013e31817445ff. [PubMed: 18520285].
19. De Boeck H. Radiology of the elbow in children. Acta Orthop Belg. 1996;62(Suppl 1):34-40. [PubMed: 9084558].
20. Silberstein MJ, Brodeur AE, Graviss ER, Luisiri A. Some vagaries of the olecranon. J Bone Joint Surg Am. 1981;63(5):722-5. [PubMed: 7240295].
21. Mhuircheartaigh JN, Lin YC, Wu JS. Bone tumor mimickers: A pictorial essay. Indian J Radiol Imaging. 2014;24(3):225-36. doi: 10.4103/0971-3026.137026. [PubMed: 25114385]. [PubMed Central: PMC4126137].
| Files | ||
| Issue | Vol 5, No 1 (2019) | |
| Section | Educational Corner | |
| DOI | https://doi.org/10.18502/jost.v5i1.3352 | |
| Keywords | ||
| Elbow; Humeral Fractures; Pediatrics; Radiography | ||
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How to Cite
1.
Hedayat E, Nicolas A, Mohammadi MA, Nabian MH. Step by Step Approach to Interpretation of Pediatric Elbow Radiography. J Orthop Spine Trauma. 2020;5(1):7-11.
