Upper Extremity Trauma: page 1 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Topics Giving Credit to Famous Authors Charles Monroe “Sparky” Schultz (1922-2000) Anatomy Thanks to Carrie Bartels Anatomy Creator of… Radiographs and Shana Jatczak for Radiographs Charlie Brown FOPH the 3D processing and FOPH BBFF segmentation! BBFF 1947: Li’l Folks Monteggia Monteggia 1950: Peanuts 2600 newspapers Galeazzi Galeazzi 21 languages Essex-Lop. Essex-Lop. 355 million readers in Fat Pads Fat Pads 75 countries Published a total of Peds Elbow Peds Elbow 17,897 strips Supracond. Supracond. “arguably the longest Lat.condyle Lat.condyle story ever told by one human being”* Med.epicon. Med.epicon. 4 4 March 1964… www.schreibman.info www.schreibman.info wikipedia.org © 2013 Ken L Schreibman, PhD/MD Slide 1 of 90 © 2013 Ken L Schreibman, PhD/MD *Professor Robert Thompson, Syracuse University Slide 2 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm What’s wrong with Charlie Brown’s arm? Elbow: [OE] el “forearm” + bow “bend” Anatomy Anatomy 3 Bones Radiographs Radiographs Humerus FOPH FOPH BBFF BBFF Monteggia Monteggia Galeazzi Galeazzi Essex-Lop. Essex-Lop. Fat Pads Fat Pads Radius Peds Elbow Peds Elbow Supracond. Supracond. Lat.condyle Lat.condyle Med.epicon. Med.epicon. 4 4 Ulna www.schreibman.info www.gocomics.com 3/6/1964 www.schreibman.info © 2013 Ken L Schreibman, PhD/MD Slide 3 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 4 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Parts of the Humerus Parts of the Ulna Anatomy Anatomy Radiographs Humerus Radiographs Humerus Coracoid Radius FOPH FOPH Scapula BBFF BBFF Monteggia Monteggia [Gr] ōlenē “elbow” Galeazzi Medial Galeazzi + krānion “head/skull” Trochlea Essex-Lop. Epicondyle Lateral Essex-Lop. “Head of the Elbow”* Coronoid Fat Pads Epicondyle Fat Pads Olecranon Peds Elbow Peds Elbow Supracond. Capitellum Supracond. Coronoid Lat.condyle [L] “small head” Lat.condyle Trochlea [Gr] “crow’s beak” Mandible Med.epicon. [Gr] “pulley” round like a ball Med.epicon. 4 round like a spool 4 www.schreibman.info Ulna www.schreibman.info Ulna © 2013 Ken L Schreibman, PhD/MD Slide 5 of 90 © 2013 Ken L Schreibman, PhD/MD *dartmouth.edu Slide 6 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info Upper Extremity Trauma: page 2 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Olecranon-Trochlea Joint “Joint Mice” Anatomy Hinge Joint Anatomy Loose bodies Radiographs Radiographs Small fragment off the FOPH Extension FOPH in joint capsule tip of the coronoid… BBFF Flexion BBFF Bone fragment Monteggia Monteggia Cartilage piece Galeazzi Olecranon Galeazzi Essex-Lop. Fossa Essex-Lop. Can limit range Fat Pads (deep) Fat Pads of motion (ROM) Peds Elbow Peds Elbow Supracond. Anterior view Supracond. In coronoid fossa Lat.condyle Coronoid Lat.condyle Limits flexion … limiting flexion Med.epicon. Fossa Med.epicon.In olecranon fossa 4 Posterior view (shallow) 4 Limits extension www.schreibman.info www.schreibman.info © 2013 Ken L Schreibman, PhD/MD Slide 7 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 8 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Parts of the Radius Radiocapitellar Joint Anatomy 3 Bones Anatomy Ball & Socket Joint Radiographs Humerus Radiographs FOPH FOPH Flex & Extend BBFF BBFF Rotate Monteggia Radial Neck Monteggia Pronation & Galeazzi Radial Head Outside the Galeazzi Supination Essex-Lop. joint capsule Essex-Lop. Fat Pads Round & flat Radius Fat Pads #1: Peds Elbow Like a disk Peds Elbow Supracond. Inside the Supracond. Radial head ALWAYS Lat.condyle joint capsule Radial Tuberosity Lat.condyle points to the Capitellum Med.epicon. (Biceps Tuberosity) Med.epicon. Regardless of how the elbow is bent 4 UlnaInsertion of Biceps Brachii Tendon 4 Regardless of how the x-ray beam is oriented www.schreibman.info www.schreibman.info © 2013 Ken L Schreibman, PhD/MD Slide 9 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 10 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Elbow Radiographs AP View Anatomy Anatomy Radiographs Radiographs FOPH FOPH BBFF BBFF X-ray Monteggia Monteggia beam Galeazzi Galeazzi Vertical Essex-Lop. Essex-Lop. Capitellum Elbow C Fat Pads Fat Pads raised to aligned Peds Elbow Peds Elbow shoulder with R Supracond. Supracond. height Lat.condyle Lat.condyle Radial head Med.epicon. Med.epicon. 4 4 Elbow straight www.schreibman.info www.gocomics.com 3/5/1964 Marty Brown www.schreibman.info C,A 34yoF © 2013 Ken L Schreibman, PhD/MD age 15½ Slide 11 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 12 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info Upper Extremity Trauma: page 3 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Lateral View Radial Head View Anatomy Anatomy Capitellum Radiographs Capitellum Radiographs FOPH X-ray aligned FOPH X-ray aligned BBFF beam with BBFF beam with Vertical angled Monteggia Radial head Monteggia Radial head Galeazzi Galeazzi 45° Essex-Lop. Essex-Lop. C R Elbow C R Elbow Fat Pads flexed Fat Pads flexed Peds Elbow 90° Peds Elbow 90° Supracond. Supracond. Lat.condyle Lat.condyle Med.epicon. Med.epicon. 4 Coronoid overlaps Radial Head 4 Eliminates Radial Head Overlap www.schreibman.info K,C 33yoF www.schreibman.info Greenspan. AJR 1982; 138: 1186 H,E 22yoF © 2013 Ken L Schreibman, PhD/MD Slide 13 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 14 of 90
Upper Extremity Trauma ElbowPart & Forearm 2: Wrist Upper Extremity Trauma Elbow & Forearm Fall On Out-Stretched Hand (FOOSH) Fall On Palm Heel (FOPH) H Anatomy R Anatomy U Radiographs Radiographs M A U TRO CAP FOPH D L FOPH BBFF I N BBFF Monteggia U A Monteggia Which load R Hyperextend Hyperextend S U A Galeazzi Wrist Wrist Galeazzi dominates Essex-Lop. Essex-Lop. ulna or L D radius N I Fat Pads Fat Pads determines A U Peds Elbow S Peds Elbow the pattern S of injury Supracond. HAND Supracond. Ulna Up Load Axial Lat.condyle Lat.condyle Radius Up Load Axial CARPUS Med.epicon. Med.epicon. Forearm Up Axial Load PALM 4 4 Fall On Fall On FOOSH Palm Palm www.schreibman.info Marty age 8½ www.schreibman.info Marty age 8½ Heel Heel © 2013 Ken L Schreibman, PhD/MD Slide 15 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 16 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Forearm is a Ring Forearm is a Ring H H Anatomy “You can’t break a ring in 1 place” U Anatomy You CAN break a ring in 1 place U Radiographs M Radiographs M FOPH This is not entirely true… TRO CAP FOPH With a direct blow, TRO CAP BBFF Yes, with a fall on the palm heel, BBFF like from a stick, Monteggia R Monteggia the forearm ring breaks in 1 place R Galeazzi causing an axial load, U A Galeazzi U A the forearm ring breaks in 2 places L D L D Essex-Lop. N I Essex-Lop. N I Fat Pads “Both Bone Forearm Fracture” Fat Pads “Nightstick fracture” A U Ulna A U Peds Elbow Fracture/Dislocations S Peds Elbow S Mid-shaft Supracond. Monteggia Supracond. Lat.condyle Lat.condyle Uncommon fracture Med.epicon. Galeazzi CARPUS Med.epicon. Uncommon mechanism CARPUS Fall On 4 Essex-Lopresti Palm 4 Heel www.schreibman.info www.schreibman.info © 2013 Ken L Schreibman, PhD/MD Slide 17 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 18 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info Upper Extremity Trauma: page 4 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm About to get a nightstick fracture… Nightstick (isolated ulna) fracture Anatomy Anatomy Treated Radiographs Radiographs w/cast FOPH FOPH BBFF BBFF Monteggia Monteggia After 1 month After 2 months Galeazzi Galeazzi Essex-Lop. Essex-Lop. Fat Pads Fat Pads Peds Elbow Peds Elbow Supracond. Supracond. Lat.condyle Lat.condyle Med.epicon. Med.epicon. 4 4 www.schreibman.info Chicago, 1968 www.schreibman.info S,E 9yoM, friend fell on the patient’s arm © 2013 Ken L Schreibman, PhD/MD Slide 19 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 20 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Forearm Ring: Both Bone Forearm Fracture Adult BBFF H Anatomy Common pattern U Anatomy Radiographs M Radiographs TRO CAP Cast not FOPH Children 7 FOPH BBFF 75% distal ⅓* months BBFF sufficient Monteggia Heal, remodel later R Monteggia for such Galeazzi <10yo, <25° U A Galeazzi unstable L D fracture. Essex-Lop. angulation OK** N I Essex-Lop. Fat Pads >10yo, >10° A U Fat Pads S So next Peds Elbow unlikely to correct Peds Elbow day…
Supracond. Ulna Up Load Axial Supracond.
Adult Radius Up Load Axial Lat.condyle Lat.condyle Med.epicon. Most require CARPUS Med.epicon. ORIF Fall On 4 Palm 4 Heel www.schreibman.info *wheelessonline.com P,Z 12yoM www.schreibman.info K,N 54yoF © 2013 Ken L Schreibman, PhD/MD **wheelessonline.com Slide 21 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 22 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Forearm Ring: Monteggia Fracture #1: Radial Head Points to Capitellum H Radial dislocation Need to look Anatomy Fracture proximal ⅓ ulna U Anatomy not so obvious closely at lateral Lateral------Not a True Lateral Radiographs M Radiographs + dislocation radial head TRO CAP FOPH FOPH BBFF relative to capitellum BBFF Monteggia Not uncommon Ulna fx is fx/dislocations Monteggia R Monteggia obvious… Galeazzi I see several of these a year U A Galeazzi can be quite Important not to miss the L D subtle Essex-Lop. N I Essex-Lop. Fat Pads radial head dislocation! A U Fat Pads Need to make True Lateral Peds Elbow Example of why understanding S Peds Elbow sure the radial injury mechanisms helps to head points to Supracond. detect fracture patterns Ulna Up Load Axial Supracond. capitellum… Rad Head Lat.condyle Lat.condyle If you see isolated ulna fx… CARPUS on all views Cap Med.epicon. Med.epicon. you need to look for the Fall On 4 radial head dislocation! Palm 4 Heel www.schreibman.info B,J 43yoM www.schreibman.info S,A 6yoF D,R 10yoF © 2013 Ken L Schreibman, PhD/MD Slide 23 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 24 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info Upper Extremity Trauma: page 5 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Giovanni Battista Monteggia (1762-1815) José Luis Bado (1903-1977) Anatomy 1814 Anatomy Montevideo, Uruguay Radiographs Radiographs (same year Colles Istituto Rizzoli, FOPH wrote his article) FOPH BBFF BBFF Bologna, Italy Monteggia 768 pages Monteggia Created Instituto de Galeazzi Galeazzi Essex-Lop. in Italian Essex-Lop. Ortopedia y Fat Pads Volume Primo Fat Pads Traumatologia, Peds Elbow 1 illustration… Peds Elbow Montevideo FOPH Supracond. Supracond. 1959, 1967: “The Lat.condyle Lat.condyle Med.epicon. Med.epicon. Monteggia Lesion” 4 4 “Pulled Elbow Syndrome” www.schreibman.info books.google.com www.schreibman.info www.jbjs.org Clin Orthop 1967 © 2013 Ken L Schreibman, PhD/MD Slide 25 of 90 © 2013 Ken L Schreibman, PhD/MD Jan_Feb 50 71-86 Slide 26 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Bado’s classification of Monteggia fractures Forearm Ring: Galeazzi Fracture H Anatomy Type 1 Type 2 Type 3 Type 4 Anatomy Fracture distal ⅓ radius U Radiographs Radiographs M + dislocation ulna at Distal TRO CAP FOPH FOPH BBFF BBFF Radio-Ulna Joint (DRUJ) Monteggia Monteggia Very uncommon R Galeazzi Galeazzi I see these twice U A Essex-Lop. Essex-Lop. a decade L D Ulna dislocation N I Fat Pads Fat Pads A U Peds Elbow • Radial Head: • Radial Head: • Rad Head: • Rad Head: Peds Elbow may be best seen S Supracond. Anterior Disloc Post. Disloc. Lat Disloc. Anterior Disloc Supracond. on wrist views Lat.condyle • Ulna Fracture • Ulna Fracture • Ulna Fx Lat.condyle Sometimes DRUJ DRUJ Radius Up Load Axial • Ulna & Rad Fx dislocation is subtle CARPUS Med.epicon. Anterior Angle Post. Angle Metaph. Proximal ⅓ Med.epicon. Helps to compare to Fall On 4 • 60% • 15% • 20% • 5% 4 contralateral wrist Palm Heel www.schreibman.info RadioGraphics 2000:20;819-836 www.schreibman.info L,K 19yoM © 2013 Ken L Schreibman, PhD/MD Slide 27 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 28 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Forearm Ring: Galeazzi Fracture Riccardo Galeazzi (1866-1952) H Anatomy Contralateral U Anatomy Galeazzi, R.: Ueber die Radiographs M Radiographs Lagebestimmung von Fremdkorpen Normal Wrist TRO CAP vermittelst Roentgen- strahlen. FOPH FOPH Zentralblatt fur Chirurgie, Leipzig, BBFF BBFF 1899, xxvi, No. 18, 529. Monteggia R Monteggia Reported his experience Galeazzi A Galeazzi D with 18 cases Essex-Lop. I Essex-Lop. (I’ve seen 4 cases) Fat Pads U Fat Pads S He was not the first to Peds Elbow Peds Elbow describe this pattern… Supracond. DRUJ Intact DRUJ Dislocated Supracond. Lat.condyle DRUJ Radius Up Load Axial Lat.condyle Med.epicon. CARPUS Med.epicon. Fall On 4 Palm 4 Heel www.schreibman.info L,R 51yoM www.schreibman.info www.jbjs.boneandjoint.org.uk © 2013 Ken L Schreibman, PhD/MD Slide 29 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 30 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info Upper Extremity Trauma: page 6 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Sir Astley Paston Cooper (1768-1841) Monteggia vs Galeazzi H H Anatomy Anatomy U Fracture: Fracture: U Radiographs Radiographs M Proximal Distal M FOPH FOPH TRO CAP Ulna Radius TRO CAP BBFF BBFF Dislocation: Dislocation: Monteggia Monteggia Proximal Distal Galeazzi Galeazzi R First published 1822 Rad-Cap DRUJ Essex-Lop. Essex-Lop. U A L D Fat Pads Fat Pads N I Peds Elbow Peds Elbow A “MU/GR” U Cooper’s “I was attacked by a MUGGER” S suspensorySupracond. Supracond. Monteggia =Ulna fx Galeazzi =Radius fx ligamentsLat.condyle of Lat.condyle MU Proximal ½ = GR Distal ½ = theMed. breastepicon. 1842 edition: 576 pages Med.epicon. Fx & Disloc are Fx & Disloc are DRUJ 4jdc.jefferson.edu 4 CARPUS Proximal Distal CARPUS www.schreibman.info www.artandarchitecture.org.uk books.google.com www.schreibman.info © 2013 Ken L Schreibman, PhD/MD page 497 Slide 31 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 32 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Monteggia vs Galeazzi Forearm Ring: Essex-Lopresti Fracture Anatomy H H Anatomy H U COMMON RARE U Impaction radial head U Radiographs M M Radiographs M TRO FOPH TRO CAP Whenever you You may never TRO CAP FOPH into capitellum CAP BBFF see an ulna fx, see one BBFF Comminuted radial head fracture Monteggia ask yourself, Monteggia Proximal migration radial shaft R Galeazzi “Am I missing a R Galeazzi U A Essex-Lop. U radial head A Essex-Lop. Disruption DRUJ L D L D N I Fat Pads N dislocation?” I Fat Pads This is a rare injury A U Peds Elbow A U Peds Elbow S Supracond. S Supracond. I’ve seen… one Lat.condyle Lat.condyle Peter Gordon Lawrence Essex- Radius Up Load Axial CARPUS Med.epicon. DRUJ Med.epicon. Lopresti (1916-1951) reported on his Fall On 4 CARPUS CARPUS 4 series of… two Palm www.schreibman.info www.schreibman.info J Bone Joint Surg Br May 1951 Heel © 2013 Ken L Schreibman, PhD/MD Slide 33 of 90 © 2013 Ken L Schreibman, PhD/MD vol 33-B no 2 244-247 Slide 34 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Forearm Ring: Essex-Lopresti Fracture Radial Head Fractures Comminuted H Anatomy 5 days later… U Anatomy impacted M Radial head fractures are common Radiographs radial head Radial head prosthesis Radiographs FOPH restores radial length TRO CAP FOPH R.C. Murray 1927-37 looked at all 1640 elbow fractures C BBFF R BBFF Radial Head/Neck fractures: Comminuted A Monteggia impacted RH Monteggia = 44% of all elbow fractures U D Galeazzi radial head I Galeazzi fracture L = 5% of all fxs at Liverpool Royal Infirmary Essex-Lop. N U Essex-Lop. Fat Pads A S Fat Pads 10%: Comminuted Peds Elbow Peds Elbow Comminuted/impacted head fractures are uncommon Supracond. Supracond.
Axial Load Up Radius Up Load Axial 14%: Radial Neck (mostly in children) Lat.condyle Lat.condyle Med.epicon. CARPUS Med.epicon. 15%: Displaced Radial Head fractures Shortened radius Fall On 4 DRUJ disruption DRUJ restored Palm 4 61%: Non-displaced Radial Head fractures www.schreibman.info L,D 41yoM Heel www.schreibman.info British J of Surgery 1940 Jul 28 106-119 © 2013 Ken L Schreibman, PhD/MD Slide 35 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 36 of 90
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Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Radial Head Fractures Fat Pads Live in Fossae Anatomy 61%: Non-displaced Radial Head fractures Anatomy Radiographs Radiographs FOPH Most Radial Head fractures are FOPH Olecranon BBFF non-displaced or minimally displaced BBFF Monteggia Monteggia Fossa Galeazzi Treated with sling/splint for a few days Galeazzi (deep) Essex-Lop. Important to begin early range of motion Essex-Lop. Fat Pads To avoid post traumatic stiffness Fat Pads Peds Elbow Peds Elbow Supracond. How do we detect a Radial Head fx Supracond. Anterior view Lat.condyle if it is non-displaced? Lat.condyle Posterior view Coronoid Med.epicon. Med.epicon. Fossa 4 #2: Fat pads are your friends 4 (shallow) www.schreibman.info www.wheelessonline.com www.schreibman.info © 2013 Ken L Schreibman, PhD/MD Slide 37 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 38 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Fat Pads on CT Fat Pads on MR Anatomy Can’t see inside Can’t see inside CAN see inside fossae Anatomy Normal Fat Pads Normal Fat Pads Fat Pads Joint effusion Radiographs fossae on lat 3D fossae on lat view on sagittal 2D CT Radiographs in Fossae in Fossae Elevated out in Fossae FOPH FOPH of Fossae BBFF Posterior BBFF Fat Pad Monteggia Anterior Monteggia Galeazzi Fat Pad Galeazzi Essex-Lop. Essex-Lop. Fat Pads Fat Pads * Peds Elbow Peds Elbow * Supracond. Supracond. Lat.condyle Lat.condyle Med.epicon. Med.epicon. Sagittal T1 Sagittal T1 Sagittal T2fs 4 3D CT Lateral view Sagittal CT 4 Sagittal CT (Fat is bright) (Fat is bright) (Fluid is bright) www.schreibman.info R,A 27yoF www.schreibman.info R,A 27yoF B,A 35yoM T,L 39yoF © 2013 Ken L Schreibman, PhD/MD Slide 39 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 40 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Elevated Fat Pads Fat Pads Not Easy To See Anatomy Fluid within the elbow joint Anatomy Look for them on lateral view Radiographs Radiographs Elevated elevates the fat pads Needs to be a good lateral view Anterior FOPH FOPH Condyles overlap Elevated BBFF Pus (septic arthritis) BBFF Fat Easier to see on PACS Posterior Pad Monteggia Pannus (rheumatoid arthritis) Monteggia You should magnify the image Fat Galeazzi Galeazzi You should adjust window/level Essex-Lop. Synovial fluid (synovitis) Essex-Lop. Pad Fat Pads Fat Pads Peds Elbow BLOOD (acute trauma) Peds Elbow Supracond. Adults: Radial Head Fracture Supracond. Lat.condyle Intra-articular fracture Lat.condyle Med.epicon. Hemarthrosis Med.epicon. 4 Sagittal CT Fat Pad Elevation 4 www.schreibman.info R,A 27yoF www.schreibman.info S,W 32yoM © 2013 Ken L Schreibman, PhD/MD Slide 41 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 42 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info Upper Extremity Trauma: page 8 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Elevated Posterior Fat Pad Normal Anterior Fat Pad Anatomy If you can see a posterior fat pad, it’s elevated! Anatomy Normally you can see a small anterior fat pad Radiographs Radiographs inside the shallow coronoid fossa FOPH Normally you can’t see the posterior fat pad FOPH BBFF because it’s tucked inside the deep olecranon fossa BBFF But it should be thin, flat, flush against the bone Monteggia Monteggia Galeazzi Galeazzi Essex-Lop. Essex-Lop. Fat Pads Fat Pads Peds Elbow Peds Elbow Supracond. Supracond. Lat.condyle Lat.condyle Med.epicon. Med.epicon. 4 H,R 23yoM D,T 28yoM L,D 55yoF 4 C,A 34yoF H,E 22yoF Z,M 44yoM www.schreibman.info www.schreibman.info © 2013 Ken L Schreibman, PhD/MD Slide 43 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 44 of 90
Upper Extremity Trauma Elbow & Forearmwikipedia.org Upper Extremity Trauma Elbow & Forearm Elevated Anterior Fat Pad #2: Fat Pads are your Friends Anatomy Sticks out like a spinnaker sail Anatomy Elevated elbow fat pads are telling Radiographs Radiographs FOPH “Sail Sign” FOPH you there is something filling the joint BBFF Not thin, flat, flush to the bone BBFF In the setting of acute trauma, Monteggia Monteggia that something is blood (hemarthrosis) Galeazzi Galeazzi Essex-Lop. Essex-Lop. In the setting of acute trauma, the blood Fat Pads Fat Pads came from an intra-articular fracture Peds Elbow Peds Elbow If the patient is an adult (skeletally mature), Supracond. Supracond. it’s telling you there’s a radial head fracture… Lat.condyle Lat.condyle Med.epicon. Med.epicon. …even if you can’t see the fracture 61%: Radial Head fractures non-displaced 4 H,R 23yoM D,T 28yoM L,D 55yoF 4 www.schreibman.info www.schreibman.info © 2013 Ken L Schreibman, PhD/MD Slide 45 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 46 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Occult Radial Head Fracture Occult Radial Head Fracture Anatomy Lateral View AP View Radial Head View Anatomy Lateral View Treated with sling Radiographs Radiographs FOPH Fat Pad Elevation FOPH Fat Pad Elevation Followup 11 days later... BBFF BBFF Monteggia Monteggia Galeazzi Galeazzi Fx! Essex-Lop. Essex-Lop. Fat Pads Fat Pads Peds Elbow Peds Elbow Supracond. Supracond. Lat.condyle Lat.condyle Med.epicon. Can’t see the Can’t see the Can’t see the Med.epicon. Can’t see the 4 radial head fx radial head fx radial head fx 4 radial head fx www.schreibman.info S,W 32yoM www.schreibman.info S,W 32yoM © 2013 Ken L Schreibman, PhD/MD Slide 47 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 48 of 90
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Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Elbow Joint Capsule Radial Neck Fractures Anatomy Fluoroscopic Contrast Contrast Anatomy When Radial Neck is outside capsule Radiographs Guided Contrastfilling the Contrast filling the Radiographs flowingCoronoid into filling the Coronoid Radial Neck fxs don’t yield hemarthrosis FOPH Arthrogram Olecranon FOPH BBFF CoronoidFossa Fossa BBFF Radial Neck fxs don’t yield fat pad elevation Fossa Fossa Monteggia Distal Neck fx Monteggia “Fell from Galeazzi Capsule distal to Galeazzi capsule bike, landing Elevated Essex-Lop. Essex-Lop. Normal on bilateral Flat Ant Fat Pads Fat Pads Flat Ant Fat Pad Fat Pad outstretched Peds Elbow Peds Elbow arms” Supracond. Needle in Radio Supracond. Neck -Capitellar joint Fx Lat.condyle Barely Capsule Lat.condyle Med.epicon. extends to doesn’t extend to Med.epicon. 4 Radial Neck Radial Neck 4 www.schreibman.info E,S 23yoF W,D 56yoM www.schreibman.info G,P 41yoM © 2013 Ken L Schreibman, PhD/MD Slide 49 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 50 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm #2: Fat Pads are your Friends Pediatric Elbow Anatomy Elevated elbow fat pads are telling Anatomy Radiographs Radiographs FOPH you there is something filling the joint FOPH BBFF In the setting of acute trauma, BBFF Monteggia that something is blood (hemarthrosis) Monteggia Galeazzi Galeazzi Essex-Lop. In the setting of acute trauma, the blood Essex-Lop. Fat Pads came from an intra-articular fracture Fat Pads Peds Elbow If the patient is an adult (skeletally mature) Peds Elbow Supracond. RADIAL HEAD FRACTURE! Supracond. Lat.condyle Lat.condyle Med.epicon. If the patient is a child (skeletally immature) Med.epicon. 4 DISTAL HUMERUS FRACTURE (81%)* 4 www.schreibman.info *RadioGraphics 1996; 16: 1446 www.schreibman.info www.gocomics.com 3/7/1964 imgur.com © 2013 Ken L Schreibman, PhD/MD Slide 51 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 52 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Elbow Ossification Centers: Elbow Ossification Centers: C Anatomy At birth, none AP view Lateral view Anatomy Capitellum AP view Lateral view Radiographs Radiographs st FOPH of the elbow FOPH 1 to ossify BBFF epiphyses are BBFF appears at Monteggia ossified. Monteggia ~ 1 year old Galeazzi Galeazzi Essex-Lop. As the child Essex-Lop. Fat Pads matures, they Fat Pads C Peds Elbow Peds Elbow C Supracond. ossify in a Supracond. Lat.condyle specific Lat.condyle Med.epicon. order… Med.epicon. 4 4 www.schreibman.info L,C 5moF www.schreibman.info www.posna.org T,V 15moF © 2013 Ken L Schreibman, PhD/MD Slide 53 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 54 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info Upper Extremity Trauma: page 10 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Elbow Ossification Centers: C Elbow Ossification Centers: C R Anatomy Capitellum AP view Lateral view Anatomy Radial Head AP view Lateral view Radiographs st Radiographs nd FOPH 1 to ossify FOPH 2 to ossify BBFF ~ 1 year old BBFF appears at Monteggia well ossified Monteggia 3-4 years old Galeazzi by 2 years old Galeazzi C Essex-Lop. Essex-Lop. C Fat Pads Fat Pads Peds Elbow C Peds Elbow C R Supracond. Supracond. Lat.condyle Lat.condyle R Med.epicon. Med.epicon. 4 4 www.schreibman.info www.posna.org F,D 29moF www.schreibman.info www.posna.org C,R 5yoF © 2013 Ken L Schreibman, PhD/MD Slide 55 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 56 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Elbow Ossification Centers: C R I Elbow Ossification Centers: C R I T Anatomy Internal(medial) AP view Lateral view Anatomy Trochlea AP view Lateral view Radiographs Radiographs th FOPH epicondyle FOPH 4 to ossify BBFF 3nd to ossify BBFF appears at Monteggia C C Monteggia ~7 years old appears at R C Galeazzi ~5 years old I Galeazzi I Essex-Lop. Essex-Lop. T C Fat Pads Fat Pads Peds Elbow R Peds Elbow R Supracond. I Supracond. R Lat.condyle Lat.condyle Med.epicon. Med.epicon. 4 4 www.schreibman.info www.posna.org P,J 5yoM www.schreibman.info www.posna.org B,A 8yoM © 2013 Ken L Schreibman, PhD/MD Slide 57 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 58 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Elbow Ossification Centers: C R I T O Elbow Ossification Centers: C R I T O E Anatomy Olecranon AP view Lateral view Anatomy External(lateral) AP view Lateral view Radiographs th Radiographs FOPH 5 to ossify FOPH epicondyle BBFF appears at I BBFF last to ossify I C Monteggia ~9 years old C Monteggia appears at O E R C Galeazzi Galeazzi ~11 years old Essex-Lop. T Essex-Lop. Fat Pads Fat Pads T Peds Elbow O Peds Elbow C R R Supracond. R Supracond. O Lat.condyle Lat.condyle Med.epicon. Med.epicon. 4 4 www.schreibman.info www.posna.org R,A 9yoF www.schreibman.info www.posna.org P,A 11yoM © 2013 Ken L Schreibman, PhD/MD Slide 59 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 60 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info Upper Extremity Trauma: page 11 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Elbow Ossification Centers: C R I T O E Causes of Pediatric Elbow Pain Anatomy Approximate age AP view Radial Head view Anatomy Radiographs Radiographs FOPH Capitellum…...1 FOPH BBFF Radial Head....3 BBFF Monteggia Monteggia Galeazzi Int. epicond....5 Galeazzi Essex-Lop. Trochlea……. .7 Essex-Lop. Fat Pads Fat Pads Peds Elbow Olecranon….. .9 Peds Elbow Supracond. Ext. epicond…11 Supracond. Lat.condyle Lat.condyle Med.epicon. … then go on to Med.epicon. 4 fuse 4 www.schreibman.info www.posna.org H,J 14yoM www.schreibman.info www.gocomics.com 3/4/1964 © 2013 Ken L Schreibman, PhD/MD Slide 61 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 62 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm FallSupracondylar On Palm Heel Fracture (FOPH) Supracondylar Fracture H Anatomy Fracturing U Anatomy Negative, No Fracture Fracture, Above Condyles Radiographs ABOVE M Radiographs FOPH Condyles TRO CAP FOPH BBFF BBFF Monteggia R Monteggia Galeazzi U A Galeazzi L D Essex-Lop. N I Essex-Lop. C Fat Pads A U Fat Pads Peds Elbow S Peds Elbow Supracond. Supracond. R Axial Load Up ForearmUp Load Axial Lat.condyle Lat.condyle CARPUS I Med.epicon. ForearmUp Load Axial PALM Med.epicon.
Fall On Axial Load Up ForearmUp Load Axial 4 Fall On 4 ForearmUp Load Axial Palm Palm www.schreibman.info Marty age 8½ Heel Heel www.schreibman.info 5y 8m F S,J 7yoF © 2013 Ken L Schreibman, PhD/MD Slide 63 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 64 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Supracondylar Fracture Supracondylar Fracture Anatomy AP view: ER AP view: OR Anatomy THE most common Radiographs Closed reduction & Radiographs FOPH fixation with K-wires FOPH pediatric elbow fx BBFF Pushed BBFF FRACTURES OF THE ELBOW IN CHILDREN Monteggia Condyles Monteggia REVIEW OF THREE HUNDRED CONSECUTIVE CASES Behind Donald J. Maylahn, M.D. Galeazzi Galeazzi and Essex-Lop. Humerus Essex-Lop. John J. Fahey, M.D., Chicago Fat Pads Fat Pads J.A.M.A. Jan. 18, 1958, Vol. 166, No. 3, p 220-228 Peds Elbow Axial Load Up Forearm Peds Elbow 60%: Supracondylar Supracond. Supracond. 24%: Marked displaced Lat.condyle Lat.condyle 32%: Non/Min displaced Med.epicon. Med.epicon. 7%:Radial Head/Neck 4 4 (Most common adult elbow fx) www.schreibman.info S,J 7yoF www.schreibman.info © 2013 Ken L Schreibman, PhD/MD Slide 65 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 66 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info Upper Extremity Trauma: page 12 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Subtle Supracondylar Fractures Subtle Supracondylar Fractures Anatomy Hard to see on the AP view Anatomy Hard to see on the Lateral view… Radiographs Day of Injury After 2 weeks After 5 weeks Radiographs FOPH FOPH …Need to use thes BBFF BBFF Monteggia Monteggia #2: Fat pads are your friends Galeazzi Galeazzi Essex-Lop. Essex-Lop. Trauma + Elevated Fat Pads = Hemarthrosis Fat Pads Fat Pads Adults: Radial Head Fracture Peds Elbow Peds Elbow Supracond. Supracond. Peds: Supracondylar Fracture (60%) Lat.condyle Lat.condyle #3: Anterior Humeral Line Med.epicon. Med.epicon. 4 4 Passes through middle ⅓ of Capitellum www.schreibman.info F,A 5yoF www.schreibman.info © 2013 Ken L Schreibman, PhD/MD Slide 67 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 68 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Subtle Supracondylar Fractures Pediatric Elbow Fractures H Anatomy Normal ContralateralCan’t Sidesee Anatomy Supracondylar Fracture U Fracturing Radiographs Radiographs M just above fracture on CAP FOPH #4:Compare to normal side FOPH Most common (60%*) Capitellum BBFF Anteriorthis AP view. Anterior BBFF Grossly displaced Monteggia HumeralClues are Humeral Monteggia Quite subtle R Galeazzi Line on Lateral Line (AHL) Galeazzi U A Fx line Elevated Fat Pads L D Essex-Lop. view… Essex-Lop. N I Fat Pads Fat Pads Anterior Humeral Line A U Elevated Compare with normal side S Peds Elbow Posterior Peds Elbow Supracond. Supracond. Fat Pad Lateral Condylar Fracture RadiusUp Load Axial Lat.condyle Lat.condyle Med.epicon. Normally passes through Supracondylar fx pushes Med.epicon. Second most common CARPUS 12%* - 19%** PALM 4 MIDDLE ⅓ of Capitellum Capitellum behind AHL 4 Fall On Palm www.schreibman.info P,B 2yoF www.schreibman.info *JAMA Jan. 18, 1958, Vol. 166, No. 3, p 220-228 Heel © 2013 Ken L Schreibman, PhD/MD Slide 69 of 90 © 2013 Ken L Schreibman, PhD/MD **RadioGraphics 1996; 16: 1446 Slide 70 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Lateral Condylar Fractures Subtle Lateral Condylar Fractures Anatomy Grossly Displaced Min. Displaced Normal Side Anatomy Presented at AP View Lateral View Radiographs Radiographs Fracture RSNA Course Elevated Elevated FOPH just above FOPH Belongs This For practicing Posterior Anterior BBFF Capitellum BBFF Fat Monteggia Here piece Monteggia Radiologists Fat Galeazzi Galeazzi Used an Pad Pad Essex-Lop. Essex-Lop. Audience Fat Pads Fat Pads Response Peds Elbow Peds Elbow System Supracond. Supracond. 50% of the Lat.condyle Lat.condyle audience Anterior Humeral Line Med.epicon. Med.epicon. missed this DOESN’T pass through 4 S,D 6yoF C,B 6yoF 4 case… Negative middle ⅓ Capitellum www.schreibman.info www.schreibman.info Courtesy of Susan John, MD © 2013 Ken L Schreibman, PhD/MD Slide 71 of 90 © 2013 Ken L Schreibman, PhD/MD Radiology Chair, UT Houston Slide 72 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info Upper Extremity Trauma: page 13 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Pediatric Elbow Fractures Medial Epicondylar Fractures Anatomy Supracondylar Fracture (55%** - 60%*) Anatomy Secondary to Elbow Dislocation Radiographs Radiographs FOPH Lateral Condylar Fracture (12%* - 19%**) FOPH Reduced Normal Side BBFF Grossly displaced Quite subtle BBFF Monteggia Most 2 – 8 years old Monteggia Galeazzi Galeazzi I? R I Essex-Lop. Mechanism: FOPH Essex-Lop. C C Fat Pads Fat Pads T T Peds Elbow Medial Epicondylar Fracture (7%** - 9%*) Peds Elbow I Supracond. Majority 8 – 15 years old Supracond. T C Lat.condyle Mechanism: 1) Elbow Dislocation (54%*) Lat.condyle R R Med.epicon. 2) Avulsion, Valgus Stress Med.epicon. 4 4 www.schreibman.info *JAMA Jan. 18, 1958, Vol. 166, No. 3, p 220-228 www.schreibman.info S,K 10yoF © 2013 Ken L Schreibman, PhD/MD **RadioGraphics 1996; 16: 1446 Slide 73 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 74 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Medial Epicondylar Fractures Subtle Medial Epicondylar Fractures Anatomy Secondary to Elbow Dislocation Anatomy Avulsions from Valgus Stress Radiographs Radiographs FOPH AP View Lateral View Normal Side FOPH Normal Side Abnormally widened BBFF BBFF Normal width Monteggia Monteggia growth plate of growth plate Galeazzi Galeazzi I I Essex-Lop. C I Essex-Lop. E Fat Pads T Fat Pads A V Valgus Stress Peds Elbow I I Peds Elbow U Supracond. Supracond. L S Common Lat.condyle R Lat.condyle I O Flexor Med.epicon. O O Med.epicon. 4 4 N Tendon www.schreibman.info S,K 10yoF www.schreibman.info H,A 14yoM © 2013 Ken L Schreibman, PhD/MD Slide 75 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 76 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm What’s wrong with Charlie Brown’s arm? Little Leaguer’s Elbow Anatomy Anatomy By MAJOR BYRON G. BROGDON, USAF (MC), Radiographs Radiographs and MAJOR NEIL E. CROW, USAF (MC) FOPH FOPH (residents at) LACKLAND AIR FORCE BASE, TEXAS BBFF BBFF American Journal of Radiology, April 1960, Vol. 83, No. 4, p 671-5 Monteggia Monteggia Referencing W.E. Dotters’ 1953 article, Galeazzi Galeazzi “Little Leaguer’s shoulder; fracture of the Essex-Lop. Essex-Lop. proximal epiphysial cartilage of the Fat Pads Fat Pads humerus due to baseball pitching.” Peds Elbow Peds Elbow Guthrie Clin. Bull., 1953, 23, 68-72 Supracond. Supracond. Go on to write, Lat.condyle Lat.condyle During the past baseball season we have seen in pubescent pitchers an injury which Med.epicon. Med.epicon. we choose to call “little leaguer’s elbow.” 4 4 The similarity of these cases is striking. www.schreibman.info www.gocomics.com 3/6/1964 www.schreibman.info Photo courtesy of Gil Brogdon, MD © 2013 Ken L Schreibman, PhD/MD Slide 77 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 78 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info Upper Extremity Trauma: page 14 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Little Leaguer’s Elbow Charlie Brown’s Elbow Anatomy Case I. C.S., a well-developed exercise the elbow. The patient was Anatomy Radiographs eleven year old fast-baller, pitched the brought to the hospital by his father Radiographs opening game of the Little League when attempted resumption of his FOPH Season. Despite an inadequate warm- pitching career reproduced the initial FOPH BBFF up he pitched a no-hitter and allowed symptoms. BBFF Monteggia only one walk! However, by the Roentgenographic study of the Monteggia middle of the game he was elbow revealed separation and Galeazzi experiencing pain over the medial fragmentation of the epiphysis of the Galeazzi Essex-Lop. epicondyle of the pitching arm with right medial epicondyle and loss of Essex-Lop. Fat Pads every throw and could not really “bear fascial marking about the elbow Fat Pads down.” For several days afterward suggesting edema or hematoma. Peds Elbow there was local tenderness and The patient was forbidden to pitch or Peds Elbow Supracond. swelling over the right medial otherwise strenuously exercise the Supracond. Lat.condyle epicondyle and pain on extreme elbow. One month later all symptoms Lat.condyle flexion or pronation of the forearm. had disappeared, but a clandestine Med.epicon. He vacationed for one month and experiment on the part of the patient Med.epicon. 4 did not pitch or otherwise violently proved that pitching still elicited pain. 4 www.schreibman.info AJR April 1960, Vol. 83, No. 4, p 671 www.schreibman.info www.gocomics.com 3/9/1964 © 2013 Ken L Schreibman, PhD/MD Slide 79 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 80 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Charlie Brown’s Elbow Little Leaguer’s Elbow in the Media Anatomy “Roentgenographic Anatomy Peanuts Comic Strip Radiographs study of the elbow Radiographs FOPH FOPH 1964: Charlie Brown has it BBFF revealed separation BBFF 1963: Snoopy was worried about it… Monteggia and fragmentation Monteggia Galeazzi of the epiphysis of Galeazzi Essex-Lop. the right medial Essex-Lop. Fat Pads epicondyle and loss Fat Pads Peds Elbow Peds Elbow Supracond. of fascial markings Supracond. Lat.condyle about the elbow Lat.condyle 1962: Magazine Articles Med.epicon. suggesting edema Med.epicon. Time: “Medicine: The Dangerous Arm” 4 or hematoma.”* 4 Life www.schreibman.info www.gocomics.com 3/9/1964 www.schreibman.info www.gocomics.com 6/26/1963 © 2013 Ken L Schreibman, PhD/MD *AJR April 1960, Vol. 83, No. 4, p 671 Slide 81 of 90 © 2013 Ken L Schreibman, PhD/MD time.com Slide 82 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Gil Brogdon on NBC’s Today 1962 Little League Baseball® Response Anatomy Anatomy It is estimated that 20 million people Radiographs Radiographs FOPH FOPH were exposed to the story and the role of BBFF BBFF radiologists, radiology, and the diagnosis Monteggia Monteggia of Little League elbow. Galeazzi Galeazzi Essex-Lop. Essex-Lop. Little League Baseball® threatened a Fat Pads Fat Pads Peds Elbow Peds Elbow lawsuit against Brogdon and Crow for Supracond. Supracond. copyright infringement for using the term Lat.condyle Lat.condyle Little League™ without permission. Med.epicon. Med.epicon. 4 4 The suit was eventually dropped. www.schreibman.info ajronline.org www.schreibman.info AJR: 192, May 2009 © 2013 Ken L Schreibman, PhD/MD Slide 83 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 84 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info Upper Extremity Trauma: page 15 of 15 Elbow & Forearm
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Little League Baseball® Response 4 Elbow Radiographs Anatomy Anatomy 1) Radial Head Point to Capitellum Radiographs Radiographs FOPH FOPH On All Views BBFF BBFF Monteggia Monteggia 2) Fat Pads are your Friends Galeazzi Galeazzi In acute trauma, elevated fat pads = Fracture Essex-Lop. Essex-Lop. Adults: Radial Head Fracture Fat Pads Fat Pads Children: Supracondylar (or Lateral Condyle) Fx Peds Elbow Peds Elbow Supracond. Supracond. 3) Anterior Humeral Line Lat.condyle Lat.condyle Should pass through middle ⅓ Capitellum Med.epicon. Med.epicon. 4 4 4) When in doubt, get the other side www.schreibman.info littleleague.org www.schreibman.info © 2013 Ken L Schreibman, PhD/MD Slide 85 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 86 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Giving Credit to Famous Authors Gil Brogdon (1929-2014) Anatomy Anatomy Emeritus Professor, Radiographs Schultz Radiographs U South Alabama FOPH Monteggia FOPH ARRS Gold Medal BBFF BBFF Recipient Monteggia Bado Monteggia Galeazzi Galeazzi Essex-Lop. Galeazzi Essex-Lop. Fat Pads Cooper Fat Pads Peds Elbow Peds Elbow Supracond. Essex-Lopresti Supracond. Lat.condyle Lat.condyle Med.epicon. Brogdon Med.epicon. 4 Only one I’ve personally worked with 4 www.schreibman.info www.schreibman.info medschoolwatercooler medschoolwatercooler © 2013 Ken L Schreibman, PhD/MD Slide 87 of 90 © 2013 Ken L Schreibman, PhD/MD amazon.com Slide 88 of 90
Upper Extremity Trauma Elbow & Forearm Upper Extremity Trauma Elbow & Forearm Questions: Forearm/Elbow Bill Receipt Cheque Spike Anatomy Anatomy Radiographs Radiographs FOPH FOPH BBFF BBFF Monteggia Monteggia Galeazzi Galeazzi Essex-Lop. Essex-Lop. Fat Pads Fat Pads Peds Elbow Peds Elbow Supracond. Supracond. Lat.condyle Lat.condyle Med.epicon. Med.epicon. 4 4 www.schreibman.info rankmytattoos.com www.schreibman.info M,S 34yoF londonbarandkitchen.com © 2013 Ken L Schreibman, PhD/MD Slide 89 of 90 © 2013 Ken L Schreibman, PhD/MD Slide 90 of 90
©Ken L Schreibman, PhD/MD 6/4/15 www.schreibman.info