12/24/2023 0 Comments Occult radial head fractureOn a true lateral radiograph, the normal anterior fat pad is seen as a radiolucent line parallel to the anterior humeral cortex and the posterior fat pad is invisible.ĭistention of a structurally intact joint causes displacement of the fat pads - the posterior fat pad moves posteriorly and superiorly and becomes visible the anterior fat pad becomes more sail-like. The elbow fat pads are situated external to the joint capsule. Look for joint effusion and soft tissue swelling The routine use of comparative views is not recommended, as it comes at a considerable cost of radiation exposure to the child 1 several studies have shown that the routine use of comparative views does not alter patient management. For the true lateral projection, the elbow should be flexed 90 degrees with the forearm supinated. Familiarity with age-variable anatomy is crucial for an accurate diagnosis.Īn AP film should be obtained with the elbow in full extension and the forearm supinated (Fig 1). The multiple ossification centers may be difficult to differentiate from fractures in the acute traumatic setting. The challenge comes from the complex developmental anatomy with multiple ossification centers that mature at different ages. By using a systematic approach to reading elbow x-rays delineated below, you can begin to feel more confident and adept at evaluating the subtle signs of pediatric fractures. Radiographic assessment of acute pediatric elbow trauma requires a firm grasp of developmental anatomy, radiographic landmarks, and common injury patterns. Is it a fracture? An ossification center? Shouldn't there be a bone there? No, it's Superman.
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