pediatric elbow interpretation

Pediatric elbow radiological interpretation: 

Pediatric elbow radiological interpretation Dr mahmoud mgahed Orthopedic surgeon

Ossification Centers of the Elbow: : 

Ossification Centers of the Elbow: C apetellum (appears age 1-2) - R adial Head (appears age 2-4) - I nteranal epicondyle (appears age 4-6) - T rochlea (appears age 8-11) - O lecranon (9-11 years) - E xternal epicondyle (appears age 10-11)

Normal elbow: 

Normal elbow al notch. Two examples of the normal notchlike step off of proximal radial metaphysis in pNormatients of different ages. A, The normal angulation between the radial neck and shaft. B, More mature elbow.

Normal elbow: 

Normal elbow Normal radial tuberosity . A, On the lateral view, the radial tuberosity is seen en face and appears as a lytic defect. B, On the frontal view, radial tuberosity is clearly recognizable. This view demonstrates the normal angulation between the radial neck and shaft .

Fat bad signs: 

Fat bad signs Fat pad signs indicate an elbow joint effusion. Lateral view shows the posterior fat pad, which is always abnormal when seen with the elbow positioned in right-angle flexion. The anterior fat pad is demonstrated and is abnormally elevated. Although the anterior fat pad may be seen without an effusion, it should not be elevated to this degree.

Normal lines: 

Normal lines humeral line is drawn along the anterior cortex of the distal humeral metaphysis and should pass through the middle third of the capitellum . Passage of the anterior humeral line either anterior to the capitellum or through the anterior third of the capitellum demonstrates that the capitellum is positioned too far posteriorly ; this finding indicates a distal humeral fracture. The dashed radiocapitellar line is drawn through the radial neck and should pass through the capitellum . This relation should be examined on a frontal view as well. Failure of the radiocapitellar line to pass through the capitellum indicates radiocapitellar dislocation.

Slide 7: 

Typical supracondylar fracture. Fracture is obvious on both the anteroposterior (A) and lateral (B) views. Lateral view demonstrates an abnormal relation of the capitellum to the anterior humeral line, which passes along the anterior margin of the capitellum . Compare these images with the lateral view of the contralateral elbow (C), which shows the anterior humeral line passing normally through the middle third of the capitellum .

Supracondylar fracture: 

Supracondylar fracture Anteroposterior (A) and lateral (B) views show significant medial and posterior displacement of a distal fragment.

Supracondylar fracture: 

Supracondylar fracture Anteroposterior view shows disruption of the medial cortex.

Supracondylar fracture: 

Supracondylar fracture ( B), the fracture is subtle and is seen only medially. Follow-up anteroposterior (C) and lateral (D) views demonstrate the fracture betteInitial lateral view (A) shows an abnormal anterior humeral line indicative of a fracture. On the initial anteroposterior view r . On the anteroposterior view in C, the fracture may clearly be seen to extend all of the way across the metaphysis .

Supracondylar fracture. Cubitus varus.: 

Supracondylar fracture. Cubitus varus . A , Anteroposterior view shows a varus deformity of the distal humerus from a previous well-healed supracondylar fracture. B, On the lateral view, the capitellum remains posteriorly positioned, a finding typical of a previous supracondylar fracture.

Baumann angle.: 

Baumann angle. A 5-year-old boy with previous left distal humeral supracondylar fracture. A, Anteroposterior view of the left elbow. B, Comparison anteroposterior view of right elbow. The Baumann angle usually is defined as the angle between the growth plate for the capitellum and a line drawn perpendicular to the humeral shaft. Rather than drawing the extra perpendicular line, the Baumann angle was measured as 90° minus the angle between the capitellar growth plate and the humeral shaft. In this patient, the uninjured right elbow has a Baumann angle of 12°, and the previously injured left elbow has a Baumann angle of only 2°. This finding indicates a varus deformity of the left distal humerus .

Lateral condyle fracture.: 

Lateral condyle fracture.

Lateral condyle fracture.: 

Lateral condyle fracture.

Lateral condyle fracture.: 

Lateral condyle fracture.

Lateral condyle fracture.: 

Lateral condyle fracture. Fat-suppressed T2-weighted coronal MRI shows that the fracture extends through the metaphysis into the epiphysis, although the articular surface remains intact .

Lateral condyle fracture with instability. : 

Lateral condyle fracture with instability. Initial anteroposterior (A) and lateral (B) views show a nondisplaced lateral condyle fracture. Subsequent views (C and D) show posterior displacement of a distal fragment.

Lateral condyle and olecranon fractures.: 

Lateral condyle and olecranon fractures.

Medial epicondyle avulsion fracture : 

Medial epicondyle avulsion fracture Medial epicondyle avulsion fracture Medial epicondyle avulsion fracture

Mediaal epicondyle entraped inside the joint: 

Mediaal epicondyle entraped inside the joint

Medial epicondyle fracture with entrapment in an 8-year-old boy.: 

Medial epicondyle fracture with entrapment in an 8-year-old boy.

Medial condyle fracture: 

Medial condyle fracture the fracture continues through the epiphysis, but it cannot be seen in this patient because the entire trochlea is still cartilage and has not yet become ossified .

Transcondylar fracture: 

Transcondylar fracture The capitellum (along with the remainder of the cartilaginous epiphysis) is medially and posteriorly displaced relative to the metaphysis . Radiocapitellar alignment remains normal .

Transcondylar fracture : 

Transcondylar fracture t his is confirmed on the arthrogram

Transcondylar fracture: 

Transcondylar fracture Subsequent radiograph shows abnormality of the medial condyle and varus deformity from a growth plate injury.

Radial neck fracture: 

Radial neck fracture

Displaced proximal radial fracture.: 

Displaced proximal radial fracture.

Olecranon avulsion fracture.: 

Olecranon avulsion fracture.

Posterolateral elbow dislocation, lateral view: 

Posterolateral elbow dislocation, lateral view

Monteggia fracture type I.: 

Monteggia fracture type I.

In a Monteggia fracture type 3,: 

In a Monteggia fracture type 3,

lateral condyle fracture with elbow dislocation,: 

lateral condyle fracture with elbow dislocation, The distal fracture fragment is displaced laterally and posteriorly . Displacement of the lateral trochlear ridge has also resulted in elbow joint instability with dislocation of the olecranon laterally and posteriorly . Radiocapitellar alignment remains normal .

Medial epicondyle avulsion fracture: 

Medial epicondyle avulsion fracture with entrapment in an older patient

Medial condyle fracture with markedly rotated distal fragment,: 

Medial condyle fracture with markedly rotated distal fragment,

Thanks for your attention: 

Thanks for your attention