Adult elbow radiograph (an approach)

Last revised by Jeremy Jones on 18 May 2021

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 doesn't, 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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Cases and figures

  • Case 1: radial head fracture
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  • Case 2: elbow dislocation
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  • Case 3: elbow dislocation with coronoid process fracture
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  • Case 4: olecranon fracture
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