The Elbow to include Paediatrics

Question 1

What is Supracondylar fracture?

Answer 1

Supracondylar fracture
AHL passing anteriorly to the capitulum due to posterior bending of the distal humeral fragment

Line drawn along the anterior aspect of the humeral shaft on a lateral
Passes through the middle 1/3 of the capitulum normally. Can only use a true lateral for assessment.
In most patients approximately one third of the capitellum lies anteriorly to this line

Question 2

Radio-capitellar Line information

Answer 2

A line drawn along the centre of the shaft of the proximal radius, on both the AP and lateral projections, should pass through the capitulum.
Good for checking dislocation of radius

Question 3

What are the important artery and nerve on the arm?

Answer 3

Location of brachial artery and median nerve important

Question 4

What is Galeazzi Fracture

Answer 4

fracture of radius with dislocation of the distal radioulnar joint
# normally seen distal/middle 3rd of radius

Question 5

What is Monteggia Fracture

Answer 5

fracture of the proximal ulna with dislocation of the radial head

Question 6

Ossification ages Acronym Critol

Answer 6

Capitulum (appears age 1-2)
Radial Head (appears age 2-4)
Internal Epicondyle (appears age 4-8)
Trochlea (8-11) }
Olecranon (9-11) } up to 12 years
Lateral Epicondyle (10-11) }

Timings may vary but order will not

At birth the distal humerus and proximal radius and ulna consist of cartilage which have no ossification centres
Six centres of ossification progressively appear until the age of 12 years in this order CRITOL
The ossification centres enlarge and fuse between the ages of 14 and 16 (except the medial epicondyle 18-19 years)

Question 7

Supracondylar fracture information

Answer 7

Most common fracture in children but rare after age 15
Uncommon in adults (3%)
Mechanism of injury – high energy trauma in children, osteoporotic bone in elderly
Will present with swollen elbow and decreased ROM
Image appearance can be very subtle, especially if non-displaced
Commonly see a posterior displacement

Look for;
Fat pad sign
Anterior humeral line
Loss of carrying angle

Risk of neurovascular injury
Volkmann Ischaemic Contracture – due to swelling on the forearm compartment leading to muscle and nerve necrosis
Trapped brachial artery, compression of brachial artery or medial nerve