41: Imaging of the Elbow (CRMTOL)

Internal Oblique View of the Elbow

Fully extended, maximally pronated and internal rotated

AP View of Elbow

Has overlap covering up radial head and radial tuberosity so harder to fully see

Normal Alignment in Children

Radio capitellar line and anterior humeral line intersect at capitulum

Year 7

Trochlea begins to ossify

Radiographs in Young Children

A different portion of the arm begins to grow each year

Fat Pad signs

1 big joint capsule for all 3 joints of elbow 1 joint injury causes edema to joint capsule Edema lifts fat bad and creates dark spot near joint

Standard Views of Forearm

AP Lateral Forearm: Fully supinated for both AP and lateral view

Standard Views of Elbow

AP Lateral Oblique: External Rotation

External Oblique View of the Elbow

Best view of radial head and radial tuberosity Position: Fully extended and supinated, arm externally rotated as far at is can go

Year 1

Capitulum begins to ossify

Lateral View of Elbow

Elbow flexed to 90 degrees and forearm fully supinated Very clear look of olecranon and radial head

Year 11

Lateral epicondyle begins to ossify

Radial Head Capitellum View

Looks a lot like lateral view and patient positioned the same Difference: X-ray image shoots at 45-degree angle instead of straight down Want to view radial head, capitulum, and olecranon

Year 5

Medial epicondyle begins to ossify

Radiographic Landmarks

Normal Orientation in Children Fat pad sign: Anterior and Posterior Abnormal supinator line

Year 9

Olecranon begins to ossify

Year 3

Radial head begins to ossify

Anterior fat pad sign

hemarthrosis in radial head fracture More common than posterior