MEDLINE Abstracts: Fractures of the Elbow: Radiologic Evaluation and Diagnosis
MEDLINE Abstracts: Fractures of the Elbow: Radiologic Evaluation and Diagnosis
What radiologic methods are used to evaluate and diagnose elbow fractures? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Orthopaedics and Sports Medicine.
Beltran J, Rosenberg ZS, Kawelblum M, Montes L, Bergman AG Strongwater A.
Skeletal Radiology 23(4):277-81, 1994 May
Magnetic resonance imaging (MRI) was performed in eight patients under the age of 8 years who suffered elbow fractures, to assess possible fracture extension into the distal nonossified epiphysis of the humerus in seven cases and to determine the displacement and location of the radial head in one case. MRI allowed accurate depiction of the fracture line when it extended into the cartilaginous epiphysis. In four cases, MRI findings were confirmed at surgery. In five cases, surgery was obviated because no articular extension of the fracture was seen on MRI (4 cases) or because no displacement was noted (1 case). In one patient, the plain film diagnosis of a Salter type II fracture was changed to Salter type IV on the basis of the MRI findings. It is concluded that MRI might play a role in the preoperative evaluation of pediatric patients presenting with elbow trauma when extension of the fracture cannot be determined with routine radiographic studies. Elbow injuries in children may be difficult to diagnose by routine clinical and radiographic techniques [1, 4, 12, 14]. Diagnostic difficulty is due to the presence of multiple ossification centers of the distal humeral epiphysis and proximal radius and ulna; these are mostly cartilaginous until the age of 11-12 years and therefore invisible on radiographs. Following distal radial and distal tibial physeal fractures, epiphyseal elbow injuries are the most frequent epiphyseal injuries [8, 16]. These fractures tend to be unstable and often require surgical intervention. In addition, lasting sequelae such as cubitus valgus and delayed ulnar nerve palsy can occur if these fractures are not treated properly [8].
Skibo L, Reed MH
Canadian Association of Radiologists Journal 45(4):287-91, 1994 Aug
In the search for a fracture of the elbow in children, the position of the anterior humeral line is a valuable aid. It has been stated that a true lateral radiograph is required to use this sign, although no criteria for assessing true laterality have been described. To develop such criteria, the authors examined 74 lateral radiographs of the elbow for 42 patients ranging in age from 9 months to 5 years, 9 months. Thirty-five of the patients did not have supracondylar fractures, and 7 did. In all of the radiographs the direction and degree of rotation, as well as the position of the anterior humeral line, were assessed relative to a series of radiographs of a cadaveric humerus in standardized positions. Examination of the humeral anatomic features in the radiographs showed that superimposition of the posterior supracondylar ridges of the humerus is the best means of confirming true laterality. This criterion is easily applied to lateral radiographs of the elbow in children. Of the radiographs reviewed, only seven were considered to represent true lateral views. Of those exposed in other degrees of rotation, the anterior humeral line gave a false indication of fracture in 19.
Davidson RS, Markowitz RI, Dormans J, Drummond DS
Journal of Bone & Joint Surgery - American Volume 76(12):1804-13, 1994 Dec
Fractures and epiphyseal injuries in the region of the elbow are uncommon in infants and young children, but they can be very difficult to diagnose and delineate accurately. In addition to plain radiography, invasive or costly procedures such as arthrography and magnetic resonance imaging traditionally have been used to evaluate these injuries. We used high-resolution real-time ultrasonography to evaluate a suspected injury of the elbow in seven infants and one ten-year-old child. Three of the infants had a physeal separation, two had a supracondylar fracture, and two had no skeletal injury. The child had an avulsion fracture of the lateral epicondyle of the humerus and an effusion in the joint. The ultrasonographic findings were confirmed by arthrography in three patients, by open reduction in one, and by follow-up radiographs in all. None of the ultrasonographic studies were performed with the patient under general anesthesia. Ultrasonography, a readily available, non-invasive technique, can be used to evaluate the unossified epiphysis about the elbow of infants and young children; to demonstrate dislocations, fractures, and physeal separations; to identify a hinge of soft tissue at the site of a fracture; to identify interposition of soft tissue between fracture fragments; and to aid in the planning of closed and open reductions.
Byers GE 3d, Berquist TH
Current Problems in Diagnostic Radiology 25(1):1-49, 1996 Jan-Feb
Participation in organized sports and fitness activity continues to increase in the United States. As a result, more acute bone and soft-tissue injuries are occurring in this patient population. Chronic overuse syndromes are also more common today. It is important for radiologists to understand the mechanism of injury so that they can properly approach the imaging of these patients. Although magnetic resonance imaging (MRI) is frequently the technique of choice, other imaging methods are also important and may, in certain cases, be preferred to MRI. In this review, we discuss extremity injuries by anatomic region. The spine is not included. A tailored imaging approach to each anatomic region and type of injury is discussed.
What radiologic methods are used to evaluate and diagnose elbow fractures? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Orthopaedics and Sports Medicine.
Beltran J, Rosenberg ZS, Kawelblum M, Montes L, Bergman AG Strongwater A.
Skeletal Radiology 23(4):277-81, 1994 May
Magnetic resonance imaging (MRI) was performed in eight patients under the age of 8 years who suffered elbow fractures, to assess possible fracture extension into the distal nonossified epiphysis of the humerus in seven cases and to determine the displacement and location of the radial head in one case. MRI allowed accurate depiction of the fracture line when it extended into the cartilaginous epiphysis. In four cases, MRI findings were confirmed at surgery. In five cases, surgery was obviated because no articular extension of the fracture was seen on MRI (4 cases) or because no displacement was noted (1 case). In one patient, the plain film diagnosis of a Salter type II fracture was changed to Salter type IV on the basis of the MRI findings. It is concluded that MRI might play a role in the preoperative evaluation of pediatric patients presenting with elbow trauma when extension of the fracture cannot be determined with routine radiographic studies. Elbow injuries in children may be difficult to diagnose by routine clinical and radiographic techniques [1, 4, 12, 14]. Diagnostic difficulty is due to the presence of multiple ossification centers of the distal humeral epiphysis and proximal radius and ulna; these are mostly cartilaginous until the age of 11-12 years and therefore invisible on radiographs. Following distal radial and distal tibial physeal fractures, epiphyseal elbow injuries are the most frequent epiphyseal injuries [8, 16]. These fractures tend to be unstable and often require surgical intervention. In addition, lasting sequelae such as cubitus valgus and delayed ulnar nerve palsy can occur if these fractures are not treated properly [8].
Skibo L, Reed MH
Canadian Association of Radiologists Journal 45(4):287-91, 1994 Aug
In the search for a fracture of the elbow in children, the position of the anterior humeral line is a valuable aid. It has been stated that a true lateral radiograph is required to use this sign, although no criteria for assessing true laterality have been described. To develop such criteria, the authors examined 74 lateral radiographs of the elbow for 42 patients ranging in age from 9 months to 5 years, 9 months. Thirty-five of the patients did not have supracondylar fractures, and 7 did. In all of the radiographs the direction and degree of rotation, as well as the position of the anterior humeral line, were assessed relative to a series of radiographs of a cadaveric humerus in standardized positions. Examination of the humeral anatomic features in the radiographs showed that superimposition of the posterior supracondylar ridges of the humerus is the best means of confirming true laterality. This criterion is easily applied to lateral radiographs of the elbow in children. Of the radiographs reviewed, only seven were considered to represent true lateral views. Of those exposed in other degrees of rotation, the anterior humeral line gave a false indication of fracture in 19.
Davidson RS, Markowitz RI, Dormans J, Drummond DS
Journal of Bone & Joint Surgery - American Volume 76(12):1804-13, 1994 Dec
Fractures and epiphyseal injuries in the region of the elbow are uncommon in infants and young children, but they can be very difficult to diagnose and delineate accurately. In addition to plain radiography, invasive or costly procedures such as arthrography and magnetic resonance imaging traditionally have been used to evaluate these injuries. We used high-resolution real-time ultrasonography to evaluate a suspected injury of the elbow in seven infants and one ten-year-old child. Three of the infants had a physeal separation, two had a supracondylar fracture, and two had no skeletal injury. The child had an avulsion fracture of the lateral epicondyle of the humerus and an effusion in the joint. The ultrasonographic findings were confirmed by arthrography in three patients, by open reduction in one, and by follow-up radiographs in all. None of the ultrasonographic studies were performed with the patient under general anesthesia. Ultrasonography, a readily available, non-invasive technique, can be used to evaluate the unossified epiphysis about the elbow of infants and young children; to demonstrate dislocations, fractures, and physeal separations; to identify a hinge of soft tissue at the site of a fracture; to identify interposition of soft tissue between fracture fragments; and to aid in the planning of closed and open reductions.
Byers GE 3d, Berquist TH
Current Problems in Diagnostic Radiology 25(1):1-49, 1996 Jan-Feb
Participation in organized sports and fitness activity continues to increase in the United States. As a result, more acute bone and soft-tissue injuries are occurring in this patient population. Chronic overuse syndromes are also more common today. It is important for radiologists to understand the mechanism of injury so that they can properly approach the imaging of these patients. Although magnetic resonance imaging (MRI) is frequently the technique of choice, other imaging methods are also important and may, in certain cases, be preferred to MRI. In this review, we discuss extremity injuries by anatomic region. The spine is not included. A tailored imaging approach to each anatomic region and type of injury is discussed.
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