Elbow radiograph (an approach)

Systematic review


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, think acute intra-articular fracture
  • if a fracture cannot be identified but an effusion is present in an adult patient, think undisplaced radial head fracture
Bone cortex

Check around every bone on the film

Common pathology

Radial head fracture

  • commonest adult elbow fracture
  • most frequently in women
  • fall on abducted arm; direct blow uncommon
  • can be subtle and easily missed
  • more: radial head fracture
Elbow dislocation

  • up to 25% of all adult elbow injuries
  • most frequently posterior
  • fall onto extended arm
  • associated radial head fracture, coronoid process fracture, or both (‘terrible triad’)
  • more: elbow dislocation
Distal humeral fracture

  • common in elderly osteoporotic patients
  • direct blow or fall on outstretched arm
  • typically intra-articular (uni- or bi-condylar)
  • more: distal humeral fracture
Olecranon fracture

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

Don't miss...

Coronoid process fracture

  • uncommon; often in association with dislocation
  • fall onto extended arm
  • fragments involving >50% coronoid process are unstable
  • check for fractures on post-reduction films
  • more: coronoid process fracture
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Publication date: 22nd Apr 2014 15:10 UTC

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