EMRad: Radiologic Approach to the Pediatric Traumatic Elbow X-ray

This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department [1]. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. We recently covered the adult elbow, here we will cover the approach to the pediatric elbow. Learning Objectives Interpret traumatic pediatric elbow x-rays using a standard approach Identify clinical scenarios in which an additional view might improve pathology diagnosis Why the pediatric elbow matters and the radiology rule of 2’s The Pediatric Elbow 10% of all pediatric fractures involve the elbow [2]. Missed injuries can cause significant deformity, pain, or functional/neurologic complications [2]. Before we begin: Make sure to employ the rule of 2’s [3] 2 views: One view is never enough. 2 abnormalities: If you see one abnormality, look for another. 2 joints: Image above and below (especially for forearm and leg). 2 sides: If unsure regarding a potential pathologic finding, compare to another side. 2 occasions: Always compare with old x-rays if available. 2 visits: Bring the patient back for repeat films. An approach to the traumatic pediatric elbow x-ray Adequacy / Alignment Effusions or Fat Pads Bones, Growth Plates, and Ossification Centers Consider an additional view 1.   Adequacy / Alignment Check for a “Figure of 8” to ensure that this is a true lateral view. Check the anterior humeral line. Pearl: Children (usually those under age 4) can have the anterior humeral line pass through the anterior third of the capitellum without associated pathology [2]. Pearl: In pediatric patients, abnormalities in the anterior humeral line can indicate a supracondylar fracture or a lateral condyle fracture Check the … Continue reading EMRad: Radiologic Approach to the Pediatric Traumatic Elbow X-ray