Elbow Quiz Please Report the Following X Rays

Elbow Quiz Please report the following x rays:

Please review the online resource before attempting the quiz:

http://www.radiologyassistant.nl/en/p58c4dd5b9219a/elbow- fractures-in-children.html

Case 1: 26 month – fall onto elbow 26 month – fall onto elbow

Report: Transverse supracondylar fracture with minimal dorsal angulation and elbow effusion. Normal radiocapitellar alignment. No distal forearm fracture with normal wrist alignment. Case 2: 5 yo, FOOSH Case 2: 5 yo, FOOSH

Report: Oblique fracture of the proximal ulnar diaphysis with slight lateral displacement and dorsal angulation. The radius is intact. Loss of alignment at the radiocapitellar articulation, with the radial head dislocated anteriorly. (It appears normal on the AP projection). No elbow effusion. No distal forearm fracture with normal wrist alignment. Appearances consistent with a Monteggia fracture/dislocation. Case 3: 15 yo, injury in pool Case 3: 15 yo, injury in pool

Report: Transverse fracture of the distal radial diaphysis with volar angulation of the distal segment. The ulna is intact. Loss of alignment at the distal radio ulnar articulation, with the distal ulna dislocated posteriorly. Normal radiocarpal alignment. No elbow effusion. No proximal forearm fracture. Appearances consistent with a Galeazzi fracture/dislocation. Case 4: 5yo, FOOSH

Bonus question: which ossification centres are present? Case 4: 5yo, FOOSH

Report: Undisplaced lateral condyle fracture. Overlying soft tissue swelling. Associated elbow effusion. Normal radiocapitellar alignment. Radius and ulna intact.

Bonus answer: The capitellum and radial head ossification centres are present. The medial epicondyle, trochlear and olecranon ossification centres are not present. Thus, the lucency in the lateral condyle must represent a fracture (rather than an ossification centre). Case 5: 5 yo FOOSH Case 5: 5 yo FOOSH

Report: Fracture of the lateral condyle with lateral displacement, anterior angulation and rotation of the distal fragment. Loss of radiocapitellar alignment; the radius is dorsally positioned relative to the capitellum. Large joint effusion and extensive soft tissue swelling. No fracture elsewhere. Case 6: 6yo, fell in playground Case 6: 6yo, fell in playground

Report: Transverse fractures of the left distal radial and ulnar diaphyses with slight dorsal angulation. Normal wrist alignment. Mild overlying soft tissue swelling.

ALSO: Undisplaced transverse supracondylar fracture with associated elbow effusion. Normal radiocapitellar alignment.

Bonus tip: When you diagnose one fracture, don’t forget to look for a second (or third) fracture. When you don’t do this you are succumbing to “search satisfaction”. Case 7: 14 yo, hyperextension injury Case 7: 14 yo, hyperextension injury

Report: Small elbow effusion with posterior fat pad. No radial or ulnar fracture. Normal radiocapitellar alignment. The capitellar, trochlear and olecranon ossification centres are partially fused. The radial head ossification is normal. The medial epicondyle ossification is not visualised in its normal position, and there is slight bony irregularity and soft tissue swelling at the medial aspect distal humerus. On the lateral projection, an ovoid bony fragment is projected within the elbow joint. Appearances are consistent with medial epicondyle avulsion fracture, with the medial epicondyle displaced into the joint.