Approach to elbow x-rays


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Anatomy

x-ray elbow lateral Elbow lateral labelled
x-ray elbow lateral Elbow lateral figure of 8

The figure of 8 should be symmetrical = indicating a true lateral view

Fat pads

x-ray elbow lateral Elbow lateral pat padslabelled

A small anterior fat pad may be normal

An abnormal anterior fat pad "sail" is caused by blood or inflammatory fluid within the joint space

In trauma, a positive fat pad sign = intra-articular fracture

Posterior fat pad is always abnormal

In trauma, any visible posterior fat pad = intra-articular fracture

Anterior humeral and radiocapitellar lines

x-ray elbow lateral Elbow lateral lines padslabelled

The Anterior Humeral Line should intersect the middle third of the capitellum on the lateral view. If not true, suspect a supracondylar fracture.

The Radiocapitellar line (through centre of the proximal shaft of the radial neck) should bisect the capitellum in ALL views (even oblique). If not, then there is radial head dislocation, requiring immediate reduction.

Bone cortices

Check for evidence of a fracture, particularly along the cortex of the distal humerus (especially children) and the radial head / neck.


Content by Dr Íomhar O' Sullivan. Last updated ÍOS 8/05/24.