Radiographic Evaluation of the Elbow

Crosby, Nicholas E.; Greenberg, Jeffrey A.

doi:10.1016/j.jhsa.2014.04.035

Cited by 17 publications

(7 citation statements)

References 5 publications

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“…On this view the condyles, the radiocapitellar joint, the trochlear articular surface, the olecranon, the radial tuberosity, and the anteromedial facet of the coronoid are demonstrated. 8 The carrying angle formed between the longitudinal axes of the humerus and the forearm can also be evaluated on AP projection (normally between 11 and 13 degrees of valgus). 9 The lateral view is performed with the beam perpendicular to the elbow joint flexed at 90 degrees.…”

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confidence: 99%

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Emergency and Trauma of the Elbow

Bazzocchi

Gómez

Bartoloni

et al. 2017

Semin Musculoskelet Radiol

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The elbow is a joint composed of three different articulations all included in the same synovial capsule, with a complex anatomy that allows two kinds of motion: flexion-extension and pronation and supination. Stabilization of the elbow is provided by osseous and ligamentous structures.When assessing the elbow in the traumatic setting, the mechanism of injury determines the pattern of osseous and ligamentous lesion, with potential important implications on elbow instability. The role of the radiologist in the assessment of the traumatic elbow requires an understanding of the most common injury mechanisms in traumatic elbow injuries. This knowledge facilitates the detection of potential secondary occult bone and soft tissue injuries that could lead to chronic instability.We analyze the acute patterns of injury of the osseous, ligamentous, musculotendinous, and neurovascular structures, with a focus on the most commonly used classifications of fractures and fracture-dislocations. We also discuss the therapeutic management of these injuries, with mention of the most frequently used surgical techniques and the commonly expected posttreatment findings.Finally, we review the repetitive microtrauma patterns of injury of the elbow joint structures and the most common pitfalls in the interpretation of elbow imaging.

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confidence: 99%

“…Medial and lateral oblique views are not routinely performed but can be useful in case of subtle injuries, especially in the pediatric population. 8 For medial and lateral oblique views, the elbow is fully extended on the radiographic table and the forearm is pronated or externally rotated, respectively.…”

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confidence: 99%

Emergency and Trauma of the Elbow

Bazzocchi

Gómez

Bartoloni

et al. 2017

Semin Musculoskelet Radiol

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“…Elbow fracture diagnosis can be challenging; detection rate has been reported to be different between orthopaedic surgeons and radiologists, attesting the elbow as the most overlooked site among the upper limb [34,35]. Standard elbow views are not always enough to avoid missed diagnoses [36,37]. In a recent X-ray and CT comparison study, 12% of patients with positive extension test and normal radiography had an occult fracture [38].…”

Section: Discussionmentioning

confidence: 99%

Novel Radiographic Indexes for Elbow Stability Assessment: Part A—Cadaveric Validation

Luceri

Cucchi

Rosagrata

et al. 2021

JOIO

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Introduction Elbow bony stability relies primarily on the high anatomic congruency between the humeral trochlea and the ulnar greater sigmoid notch. No practical tools are available to distinguish different morphotypes of the proximal ulna and herewith predict elbow stability. The aim of this study was to assess inter-observer reproducibility, evaluate diagnostic performance and determine responsiveness to change after simulated coronoid process fracture for three novel elbow radiographic indexes. Methods Ten fresh-frozen cadaver specimens of upper limbs from human donors were available for this study. Three primary indexes were defined, as well as two derived angles: Trochlear Depth Index (TDI); Posterior Coverage Index (PCI); Anterior Coverage Index (ACI); radiographic coverage angle (RCA); olecranon–diaphisary angle (ODA). Each index was first measured on standardized lateral radiographs and subsequently by direct measurement after open dissection. Finally, a type II coronoid fracture (Regan and Morrey classification) was created on each specimen and both radiographic and open measurements were repeated. All measurements were conducted by two orthopaedic surgeons and two dedicated musculoskeletal radiologists. Results All three indexes showed good or moderate inter-observer reliability and moderate accuracy and precision when compared to the gold standard (open measurement). A significant change between the radiographic TDI and ACI before and after simulated coronoid fracture was observed [TDI: decrease from 0.45 ± 0.03 to 0.39 ± 0.08 (p = 0.035); ACI: decrease from 1.90 ± 0.17 to 1.58 ± 0.21 (p = 0.001)]. As expected, no significant changes were documented for the PCI. Based on these data, a predictive model was generated, able to identify coronoid fractures with a sensitivity of 80% and a specificity of 100%. Conclusion New, simple and easily reproducible radiological indexes to describe the congruency of the greater sigmoid notch have been proposed. TDI and ACI change significantly after a simulated coronoid fracture, indicating a good responsiveness of these parameters to a pathological condition. Furthermore, combining TDI and ACI in a regression model equation allowed to identify simulated fractures with high sensitivity and specificity. The newly proposed indexes are, therefore, promising tools to improve diagnostic accuracy of coronoid fractures and show potential to enhance perioperative diagnostic also in cases of elbow instability and stiffness. Level of evidence Basic science study. Clinical relevance The newly proposed indexes are promising tools to improve diagnostic accuracy of coronoid fractures as well as to enhance perioperative diagnostic for elbow instability and stiffness.

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“…Multiple factors, such as fragment number, fragment displacement, articular impaction or radiocapitellar malalignment [4] as well as osteochondral lesions, loose joint bodies and elbow instability should guide surgical treatment [5]. In order to assess these factors, conventional radiographs (CR) in three planes are still the diagnostic standard [4, 6] while computed tomography (CT) and magnetic resonance imaging (MRI) are only occasionally applied to increase information about complex or ligamentous injury patterns [7].…”

Section: Introductionmentioning

confidence: 99%

The value of elbow arthroscopy in diagnosing and treatment of radial head fractures

Haasters

Helfen

Böcker

et al. 2019

BMC Musculoskelet Disord

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Background Surgical treatment of radial head fractures is increasingly performed arthroscopically. These fractures often feature concomitant injuries to the elbow joint, which may be under-diagnosed in the radiological examinations. Little is known about the diagnostic value of arthroscopy, the treatment options that arise from arthroscopically assisted fracture fixation and clinical results. We hypothesized that arthroscopy can detect additional concomitant injuries and simultaneously expands the therapeutic options. Therefore aim of this study was to compare arthroscopic and radiologic findings, to assess the distinct arthroscopic procedures and to follow up on the clinical outcomes. Methods Twenty patients with radial head fractures were retrospectively included in two study centers. All patients underwent elbow arthroscopy due to at least one of the following suspected concomitant injuries: osteochondral lesions of the humeral capitellum, injuries of the collateral ligaments or loose joint bodies. Preoperative radiological findings were compared to arthroscopic findings. Afterwards, arthroscopic treatment options and clinical outcomes were assessed. Results Arthroscopic findings led to revision of the classified fracture type in 70% ( p = 0.001) when compared to preoperative conventional radiographs (CR) and in 9% ( p = 0.598) when compared to computed tomography (CT) or magnetic resonance imaging (MRI). Diagnosis of loose bodies was missed in 60% ( p < 0.001) of the CR and in 18% ( p = 0.269) of the CT/MRI scans. Osteochondral lesions were not identified in 94% (p < 0.001) of the CR and in 27% ( p = 0.17) of the CT/MRI scans. Percutaneous screw fixation was performed in 65% and partial radial head resection in 10%. Arthroscopy revealed elbow instability in 35%, leading to lateral collateral ligament reconstruction. After a mean follow up of 41.4 ± 3.4 months functional outcome was excellent in all cases (DASH-Score 0.6 ± 0.8; MEPI-Score 98.5 ± 2.4; OES-Score 47.3 ± 1.1). Conclusions Elbow arthroscopy has a significant diagnostic value in radial head fractures when compared to standard radiological imaging. Although statistically not significant, arthroscopy also revealed concomitant injuries in patients that presented with an uneventful MRI/CT. Furthermore, all intraarticular findings could be treated arthroscopically allowing for excellent functional outcomes. Trial registration Institutional Review Board University of Munich (LMU), Trial Number 507–14.

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Radiographic Evaluation of the Elbow

Cited by 17 publications

References 5 publications

Emergency and Trauma of the Elbow

Emergency and Trauma of the Elbow

Novel Radiographic Indexes for Elbow Stability Assessment: Part A—Cadaveric Validation

The value of elbow arthroscopy in diagnosing and treatment of radial head fractures

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