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PEM Ortho X-ray Curriculum

Common Presentations

x-ray showing lateral condyle fracture
FIGURE 2 a)

 

x-ray shows a lateral condyle fracture
FIGURE 2 b)
  • FIGURE 2 (a & b) shows lateral condyle fracture

    • 20% of distal humeral fractures
      • high potential for non-union
    • Considered Salter-Harris IV injury. If undisplaced, place in long arm splint. If displaced > 2 mm, may need reduction.

 

x-ray shows radial neck fracture
FIGURE 3 a)
x-ray shows radial neck fracture
FIGURE 3 b)

Labeled x-ray

  • FIGURE 3 (a & b) shows radial neck fracture (relatively uncommon)

    • Usually from Fall On Out Stretched Hand (FOOSH)
      • tend to occur in older children
      • diagnosis should still be considered in younger children if the history does not suggest a classic pulling injury
    • Will see localized swelling, ecchymosis, tenderness over proximal radius
    • Fat pads may be normal on x-ray
    • Flexion and extension of the elbow are frequently unremarkable. There will often be tenderness over the radial head.  Supination and pronation may be more limited and/or painful.
    • Elbow should be immobilized
      • consider orthopedic referral if fracture vertex angulation > 15 degrees

FIGURE 4 a)

FIGURE 4 b)

  • FIGURE 4: Medial Epicondyle Fracture

    • Often associated with elbow dislocations which have spontaneously reduced
    • Medial epicondyle may become incarcerated in the joint
      • appearance of an ossific nucleus
x-ray showing a supracondylar fracture
FIGURE 5
  • FIGURE 5: Supracondylar Fracture

    • This represents 60% of elbow fractures; most common cause of traumatic elbow effusion
    • Reduction often required when capitellum located posterior to anterior border of humerus
    • Higher rate of complications
      • Nerve Injury (7%)
      • Volkmann's Ischemia (0.5%)
      • Cubitus Varus