Elbow radiographs obtained after trauma should evaluate for fracture and dislocation.
In pediatric patients, remember the order of appearance for ossification centers on radiography with mnemonic CRITOE sequence.
C apitellum
R adial head
I nternal (medial) epicondyle
T rochea
O lecranon
E xternal (lateral) epicondyle
If a late ossification center becomes radiographically visible prior to an earlier ones, suspect underlying avulsion fracture.
The following are especially helpful in pediatric patients to assess for traumatic misalignment:
- Radiocapitellar line
- Drawn through center of radius long axis, should pass through the mid capitellum on all projections
- Drawn through center of radius long axis, should pass through the mid capitellum on all projections
- Anterior humeral line
- Drawn along anterior surface of humerus, should pass through mid capitellum on lateral view
Look carefully at the supracondylar cortices for subtle irregularity or lucency, especially along margins of olecranon fossa on AP view. Use anterior humeral line to look for subtle displacement and/or angulation. If supracondylar fracture is present, describe the degree of displacement and angulation.
FINDINGS:
Supracondylar fracture with dorsal angulation. Radiocapitellar alignment is normal. Large elbow effusion.
Example report negative for traumatic injury:
FINDINGS:
- No acute fracture. Normal elbow aligment. No effusion.
IMPRESSION:
- No acute fracture or traumatic malalignment.