Adult elbow radiograph (an approach)

Last revised by Daniel J Bell on 3 Apr 2023

Whenever you look at an adult elbow x-ray, review:

  • alignment

  • fat pads for effusion

  • bony cortex

Check the anterior humeral line:

  • drawn down the anterior surface of the humerus

  • should intersect the middle 1/3 of the capitellum

  • if it does not, think: distal humeral fracture

Check the radiocapitellar line:

Check for raised fat pads:

  • visible posterior fat pad always indicates an elbow effusion

  • visible anterior fat pad may be seen in normal patients and should only be thought of as an indicator of an elbow effusion when massively raised

  • if there is an effusion in an adult patient, think: acute intra-articular fracture and go looking for it

  • if a fracture cannot be identified but an effusion is present, think: undisplaced radial head fracture

Check around every bone on the film

  • commonest adult elbow fracture; most frequently in women

  • mechanism: fall on abducted arm; direct blow uncommon

  • can be subtle and easily missed

  • more...

  • up to 25% of all adult elbow injuries; most frequently posterior

  • mechanism: fall onto extended arm

  • associated radial head fracture, coronoid process fracture, or both (‘terrible triad’)

  • more...

  • common in elderly osteoporotic patients

  • mechanism: direct blow or fall on outstretched arm

  • typically intra-articular; unicondylar or bicondylar fractures

  • more...

  • common, represent 10% of all adult upper extremity fractures

  • mechanism: direct blow, fall on an outstretched hand with flexed elbow, avulsion fracture or stress fracture

  • typically widely displaced due to unopposed pull of triceps

  • more...

  • uncommon; often in association with dislocation

  • mechanism: fall onto extended arm

  • fragments involving >50% coronoid process are unstable

  • check for fractures on post-reduction films

  • more...


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