# in children elbow

8/9/2019 # in Children Elbow

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Fractures Around Elbow in Children

Dr. Amrit Koirala, M.D.


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Elbow fractures are among the most

common fractures in children.

The assessment of the elbow can be

difficult because of the changing anatomy

of the growing skeleton and the subtility of

some of these fractures.


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Important Questions

- Joint Effusion ?

- Normal Alignment ?

- Ossification Centers Normal ?


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Is there a sign of joint

effusion?

After trauma this almost always indicates

the presence of hemarthros due to afracture (either visible or occult).


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Fat Pad Sign and Joint effusion

Normally on a lateral view of the elbowflexed in 90 a fat pad is seen on theanterior aspect of the joint .

This is normal fat located in the jointcapsule.

On the posterior side no fat pad is seensince the posterior fat is located within the

deep intercondylar fossa.


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Positive fat pad sign

Distention of the joint will cause the anterior fat

pad to become elevated sail sign and the

posterior fat pad to become visible.

An elevated anterior lucency and/or a visible

posterior lucency on a true lateral radiograph of

an elbow flexed at 90 is described as a positive

fat pad sign (figure).


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Figure 2. Illustration demonstrates how distentionof the joint capsule elevates both anterior

(arrow, a) and posterior (arrow, p) fatpads. Shaded gray area represents the potential

joint space, which, when distended, elevatesthe fat pads (clear or white areas).


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Important Questions

- Joint Effusion ?




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Radiocapitellar line

A line drawn through the long axis of theradius should always point toward thecentre of the capitellum whatever the

positioning of the patient, since the radiusarticulates with the capitellum (figure).

In dislocation of the radius this line will notpass through the centre of the capitellum.


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Anterior Humeral line.

A line drawn on a lateral view along the anterior

surface of the humerus should pass through the

middle third of the capitellum.

In cases of a supracondylar fracture the Anterior

Humeral line usually passes through the anterior

third of the capitellum or in front of the capitellum

due to posterior bending of the distal humeral

fragment.


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Important Questions

- Joint Effusion ?




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Ossification centres

There are 6 ossification centres aroundthe elbow joint.

They appear and fuse to the adjacentbones at different ages.

It is important to know the sequence ofappearance since the ossification centersalways appear in a strict order.


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This order of appearance is specified inthe mnemonic C-R-I-T-O-E (Capitellum -

Radius - Internal or medial epicondyle -Trochlea - Olecranon - External or lateralepicondyle).

The ages at which these ossificationcentres appear are highly variable anddiffer between individuals.

It is not important to know these agesexactly, but as a general guide forremembrance is 1-3-5-7-9-11 years.


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In a

1. Know where is the capitellum - the

center point of elbow.

2. Know the ossification centers

3. Look for fat pad sign.


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