$occult supracondylar fracture treatment$

#OCCULT SUPRACONDYLAR FRACTURE TREATMENT FULL#

The radiocapitellar line evaluates the relationship of the proximal radius to the capitellum on all views (Fig 4). This sign relies on adequate ossification of the capitellum and therefore is reliable in children over the age of 4 years only. Malalignment indicates a fracture - in most cases, posterior displacement of the capitellum in a supracondylar fracture. The anterior humeral line is drawn along the anterior cortex of the humerus and should bisect the middle third of the capitellum. Malalignment usually indicates fractures. The lines assess the geometric relationship of one bone to the other. The anterior humeral and radiocapitellar lines are used to assess elbow alignment. For suspected occult fractures, standard of care remains posterior elbow splinting with follow-up radiographs at 7-10 days. In cases where an occult fracture is suspected, follow-up radiographs in 7-10 days can be obtained to evaluate for the presence or absence of sclerosis or periosteal new bone formation as indicators of healing. The study found that 57% of imaging where the only finding was joint effusion had a fracture and 100% had bone marrow edema on MRI. 5 showed that a joint effusion without visible fracture seen on conventional radiographs is often associated with an occult fracture and bone marrow edema on MRI.

$occult supracondylar fracture treatment$

An elbow joint effusion without a visible fracture seen on radiographs can suggest an occult fracture and should prompt further evaluation.Ī study by Major et al. On the lateral x-ray of the elbow, a joint effusion can be inferred when there is displacement of the anterior fat-pad or presence of the posterior fat pad. On 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

$occult supracondylar fracture treatment$

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.

#OCCULT SUPRACONDYLAR FRACTURE TREATMENT FULL#

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.

$occult supracondylar fracture treatment$

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.

$occult supracondylar fracture treatment$

Occult supracondylar fracture treatment