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The Child’s Elbow




                       C. Noel Henley, MD
    http://www.noelhenley.com
Acute Injury




  http://www.noelhenley.com
Acute Injury
• Primary goals of initial evaluation of acute
  injury




               http://www.noelhenley.com
Acute Injury
• Primary goals of initial evaluation of acute
  injury
  -   assess neurovascular status




               http://www.noelhenley.com
Acute Injury
• Primary goals of initial evaluation of acute
  injury
  -   assess neurovascular status
  -   determine urgency of reduction




               http://www.noelhenley.com
Radiographic Anatomy




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Radiographic Anatomy
• Centers of secondary ossification




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Radiographic Anatomy
• Centers of secondary ossification
 - predictable order




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http://www.noelhenley.com
Radiographic Anatomy




      http://www.noelhenley.com
Radiographic Anatomy
• Multiple ossification centers may be
  mistaken for a fracture




              http://www.noelhenley.com
Radiographic Anatomy
• Multiple ossification centers may be
  mistaken for a fracture
• Radiographs of the opposite elbow may
  help




              http://www.noelhenley.com
Radiographic Anatomy




      http://www.noelhenley.com
Radiographic Anatomy
• Relationships to look for




              http://www.noelhenley.com
Radiographic Anatomy
• Relationships to look for
 - capitellum should always line up with
    radial head - if not...




               http://www.noelhenley.com
Radiographic Anatomy
• Relationships to look for
 - capitellum should always line up with
    radial head - if not...
   • lateral condyle fracture




               http://www.noelhenley.com
Radiographic Anatomy
• Relationships to look for
 - capitellum should always line up with
    radial head - if not...
   • lateral condyle fracture
   • Monteggia fracture



               http://www.noelhenley.com
Radiographic Anatomy
• Relationships to look for
 - capitellum should always line up with
    radial head - if not...
   • lateral condyle fracture
   • Monteggia fracture
   • elbow dislocation

               http://www.noelhenley.com
http://www.noelhenley.com
Radiographic Anatomy




      http://www.noelhenley.com
Radiographic Anatomy
• Relationships to look for




              http://www.noelhenley.com
Radiographic Anatomy
• Relationships to look for
 - anterior humeral line




              http://www.noelhenley.com
Radiographic Anatomy
• Relationships to look for
 - anterior humeral line
    • should bisect the capitellum on a lateral
      radiograph - if not...




              http://www.noelhenley.com
Radiographic Anatomy
• Relationships to look for
 - anterior humeral line
    • should bisect the capitellum on a lateral
      radiograph - if not...
      - suspect a supracondylar humerus
        fracture


              http://www.noelhenley.com
http://www.noelhenley.com
http://www.noelhenley.com
Examination




 http://www.noelhenley.com
Examination
• Tips on examining the painful child




              http://www.noelhenley.com
Examination
• Tips on examining the painful child
 - observation




              http://www.noelhenley.com
Examination
• Tips on examining the painful child
 - observation
    • arm/elbow held close?




              http://www.noelhenley.com
Examination
• Tips on examining the painful child
 - observation
    • arm/elbow held close?
    • elbow flexed/extended/pronated?




              http://www.noelhenley.com
Examination
• Tips on examining the painful child
 - observation
    • arm/elbow held close?
    • elbow flexed/extended/pronated?
    • bruising, dimpling of skin (esp. anterior
      elbow)?

               http://www.noelhenley.com
Examination




 http://www.noelhenley.com
Examination
• Tips on examining the painful child




              http://www.noelhenley.com
Examination
• Tips on examining the painful child
 - palpation (joint above, joint below, too)




              http://www.noelhenley.com
Examination
• Tips on examining the painful child
 - palpation (joint above, joint below, too)
    • start with other side




              http://www.noelhenley.com
Examination
• Tips on examining the painful child
 - palpation (joint above, joint below, too)
    • start with other side
    • lateral, medial “bones” + olecranon
      process + radial head/neck



              http://www.noelhenley.com
Examination
• Tips on examining the painful child
 - palpation (joint above, joint below, too)
    • start with other side
    • lateral, medial “bones” + olecranon
      process + radial head/neck
    • pain worse with pro/sup than with flex/
      extension?
              http://www.noelhenley.com
Thanks!

      Find out more at
http://www.noelhenley.com



         www.noelhenley.com

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Pediatric Elbow - Examination and X-rays

Editor's Notes

  1. \n
  2. \n
  3. \n
  4. \n
  5. \n
  6. \n
  7. - capitellum usually by 1yo\n- lateral condyle usually last (10yo)\n
  8. \n
  9. \n
  10. \n
  11. \n
  12. \n
  13. \n
  14. \n
  15. - capitellum and radial head line up on all views\n
  16. - fat pad may be helpful but...\n- small anterior fat pad on lateral may be normal; posterior fat pad should not be visible (indicates an intra-articular injury 90% of the time)\n
  17. - fat pad may be helpful but...\n- small anterior fat pad on lateral may be normal; posterior fat pad should not be visible (indicates an intra-articular injury 90% of the time)\n
  18. - fat pad may be helpful but...\n- small anterior fat pad on lateral may be normal; posterior fat pad should not be visible (indicates an intra-articular injury 90% of the time)\n
  19. - fat pad may be helpful but...\n- small anterior fat pad on lateral may be normal; posterior fat pad should not be visible (indicates an intra-articular injury 90% of the time)\n
  20. - capitellum and radial head line up on all views\n
  21. - capitellum and radial head line up on all views\n
  22. \n
  23. \n
  24. \n
  25. \n
  26. \n
  27. - tenderness often well-localized in elbow fractures. \n- radial neck fractures may be subtle (no fat pad [extra-capsular], xrays look OK)\n
  28. - tenderness often well-localized in elbow fractures. \n- radial neck fractures may be subtle (no fat pad [extra-capsular], xrays look OK)\n
  29. - tenderness often well-localized in elbow fractures. \n- radial neck fractures may be subtle (no fat pad [extra-capsular], xrays look OK)\n
  30. - tenderness often well-localized in elbow fractures. \n- radial neck fractures may be subtle (no fat pad [extra-capsular], xrays look OK)\n
  31. - tenderness often well-localized in elbow fractures. \n- radial neck fractures may be subtle (no fat pad [extra-capsular], xrays look OK)\n
  32. \n