Utility of Computed Tomography in Elbow Trauma Patients with Normal X-Ray Study and Positive Elbow Extension Test

Acar, Kerim; Aksay, Ersin; Oray, Deniz; Imamoğlu, Tuna; Gunay, Erkan

doi:10.1016/j.jemermed.2015.03.009

Cited by 12 publications

(8 citation statements)

References 7 publications

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“…19 MRI is more accurate to distinguish biceps tendinosis, partial tears, or complete tears (►Fig. 14). Partial tears can be seen with increased T2 signal in the tendon substance and can sometimes be difficult to differentiate from tendinosis.…”

Section: Distal Biceps Tendon Tearsmentioning

confidence: 99%

“…MRI may play a role in detecting occult fractures and osteochondral lesions that can be missed on radiographs and CT. 16 MRI may also be useful in the acute phase for evaluating high-performance athletes with elbow dislocations because it has a higher sensitivity for detection and is better for characterizing ligamentous injuries. 14 Magnetic resonance arthrography (MRA) is generally performed in the chronic setting to assess posterolateral rotatory subluxation and severe valgus injuries, and it can guide arthroscopic and surgical intervention. MRA through distension of the joint capsule with intra-articular contrast improves conventional MRI sensitivity in the evaluation of partial ligament tears and early osteochondral injuries.…”

mentioning

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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Section: Distal Biceps Tendon Tearsmentioning

confidence: 99%

mentioning

confidence: 99%

Emergency and Trauma of the Elbow

Bazzocchi

Gómez

Bartoloni

et al. 2017

Semin Musculoskelet Radiol

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“…We used CT scan to assess the size of the fracture and the position or origin of dislocated fragments as well as to exclude ulnar and humeral fractures not apparent on x-ray imaging. 1 There seems to be little or no value of CT compared with magnetic resonance imaging to depict soft tissue injuries in the acute setting, which makes lateral ligament tear basically an intraoperative finding. [2][3][4][5][6][7][8][9][10][11] Furthermore, information obtained by magnetic resonance imaging has been proven to be ineffective for patient treatment.…”

Section: Discussionmentioning

confidence: 99%

Isolated displaced type II partial articular radial head fracture: correlation of preoperative imaging with intraoperative findings of lateral ulnar collateral ligament tear

Tarallo

Porcellini

Merolla

et al. 2020

Journal of Shoulder and Elbow Surgery

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“…Haapamaki et al investigated 56 patients a with blunt elbow trauma and found that CT revealed 13 fractures that had been missed by plain x-ray study [30]. Acar et al demonstrated that CT revealed fractures in 12.8% of patients, with positive elbow extension test and normal x-ray study [31]. In terms of interobserver reliability CT examination revealed better results than CR concerning radial head classification [32].…”

Section: Discussionmentioning

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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Utility of Computed Tomography in Elbow Trauma Patients with Normal X-Ray Study and Positive Elbow Extension Test

Cited by 12 publications

References 7 publications

Emergency and Trauma of the Elbow

Emergency and Trauma of the Elbow

Isolated displaced type II partial articular radial head fracture: correlation of preoperative imaging with intraoperative findings of lateral ulnar collateral ligament tear

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

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