Paediatric elbow radiograph (an approach)

Dr Henry Knipe and Dr Jeremy Jones et al.

Paediatric elbow radiographs are commonly encountered in the emergency department and when approached in a standard fashion, not as difficult to interpret as most people think!

Ossification

Check that the ossification centres are present and in the correct position. They appear in a predictable order and can be remembered by the mnemonic CRITOE (age of appearance are approximate):

  • capitellum (age 1)
  • radial head (age 3)
  • internal epicondyle (age 5)
  • trochlea (age 7)
  • olecranon (age 9)
  • external epicondyle (age 11)
Alignment

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 supracondylar fracture

Check the radiocapitellar line:

Effusion

Check for raised fat pads:

Bone cortex

Check around every bone on the film:

Supracondylar fracture
Lateral condyle fracture
  • 10-20% of all paediatric elbow injuries
  • peak age: 6-10 years
  • mechanism: usually varus force applied to an extended elbow
  • unstable intra-articular fracture
  • prone to displacement due to the pull of forearm extensors
  • more: lateral condyle fracture
Medial epicondyle avulsion
Radial head dislocation
Radial neck fracture
  • 5% of all paediatric elbow fractures
  • peak age: 8-11 years
  • mechanism: FOOSH with extended elbow and supinated forearm
  • most fractures involve the physis
  • more: radial neck fracture
Olecranon fracture

Approaches to radiographs
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Article Information

rID: 28111
Section: Approach
Synonyms or Alternate Spellings:
  • Paediatric elbow radiographs
  • Pediatric elbow radiograph
  • Paediatric elbow x-ray
  • Pediatric elbow x-ray

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    Normal AP radiogr...
    Figure 1: ossification centres
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    Figure 2: anterior humeral line
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    Figure 3: radiocapitellar line
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    Case 1: elbow effusion
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    Case 2: supracondylar fracture
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    Case 4: medial epicondyle avulsion
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    Case 3: lateral condyle fracture
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    Case 5: radial head dislocation
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    Case 6: olecranon fracture
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