Semin Musculoskelet Radiol 2010; 14(4): 394-411
DOI: 10.1055/s-0030-1263255
© Thieme Medical Publishers

Imaging Acute Trauma of the Elbow

Humberto G. Rosas1 , Kenneth S. Lee1
  • 1Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
Further Information

Publication History

Publication Date:
08 September 2010 (online)

ABSTRACT

Elbow injuries, both acute and chronic, continue to rise as both the young and elderly increase their participation in athletic activities. The role of imaging is to provide supportive data as to the cause of the patient's symptoms and to guide treatment options for the referring physician. Understanding the anatomy and biomechanics of this sophisticated joint, various injury patterns, and the implication of injury to the static and dynamic stabilizers will result in improvement in diagnostic accuracy. Each of these topics are discussed to provide a foundation and overview of key concepts necessary to understand common elbow injuries.

REFERENCES

  • 1 Prasad A, Robertson D D, Sharma G B, Stone D A. Elbow: the trochleogingylomoid joint.  Semin Musculoskelet Radiol. 2003;  7(1) 19-25
  • 2 Boone D C, Azen S P. Normal range of motion of joints in male subjects.  J Bone Joint Surg Am. 1979;  61(5) 756-759
  • 3 Morrey B F, Askew L J, Chao E Y. A biomechanical study of normal functional elbow motion.  J Bone Joint Surg Am. 1981;  63(6) 872-877
  • 4 Frostick S P, Mohammad M, Ritchie D A. Sport injuries of the elbow.  Br J Sports Med. 1999;  33(5) 301-311
  • 5 Kapandji A. Biomechanics of pronation and supination of the forearm.  Hand Clin. 2001;  17(1) 111-122, vii
  • 6 Beals R K. The normal carrying angle of the elbow. A radiographic study of 422 patients.  Clin Orthop Relat Res. 1976;  (119) 194-196
  • 7 Morrey B F. Anatomy of the elbow joint. In: Morrey BF The Elbow and Its Disorders. Philadelphia, PA; W.B. Saunders 1993: 16-52
  • 8 Morrey B F, An K N. Articular and ligamentous contributions to the stability of the elbow joint.  Am J Sports Med. 1983;  11(5) 315-319
  • 9 Larson S G. Phylogeny. In: Morrey BF The Elbow and Its Disorders. Philadelphia, PA; W.B. Saunders 1993: 6-15
  • 10 Shiba R, Sorbie C, Siu D W, Bryant J T, Cooke T D, Wevers H W. Geometry of the humeroulnar joint.  J Orthop Res. 1988;  6(6) 897-906
  • 11 Halls A A, Travill A. Transmission of pressures across the elbow joint.  Anat Rec. 1964;  150 243-247
  • 12 Callaway G H, Field L D, Deng X H et al.. Biomechanical evaluation of the medial collateral ligament of the elbow.  J Bone Joint Surg Am. 1997;  79(8) 1223-1231
  • 13 Morrey B F, An K N. Functional anatomy of the ligaments of the elbow.  Clin Orthop Relat Res. 1985;  (201) 84-90
  • 14 Fuss F K. The ulnar collateral ligament of the human elbow joint. anatomy, function and biomechanics.  J Anat. 1991;  175 203-212
  • 15 Floris S, Olsen B S, Dalstra M, Søjbjerg J O, Sneppen O. The medial collateral ligament of the elbow joint: anatomy and kinematics.  J Shoulder Elbow Surg. 1998;  7(4) 345-351
  • 16 Timmerman L A, Andrews J R. Histology and arthroscopic anatomy of the ulnar collateral ligament of the elbow.  Am J Sports Med. 1994;  22(5) 667-673
  • 17 Hotchkiss R N, Weiland A J. Valgus stability of the elbow.  J Orthop Res. 1987;  5(3) 372-377
  • 18 O'Driscoll S W, Bell D F, Morrey B F. Posterolateral rotatory instability of the elbow.  J Bone Joint Surg Am. 1991;  73(3) 440-446
  • 19 Nestor B J, O'Driscoll S W, Morrey B F. Ligamentous reconstruction for posterolateral rotatory instability of the elbow.  J Bone Joint Surg Am. 1992;  74(8) 1235-1241
  • 20 O'Driscoll S W, Morrey B F, Korinek S, An K N. Elbow subluxation and dislocation. A spectrum of instability.  Clin Orthop Relat Res. 1992;  (280) 186-197
  • 21 Dunning C E, Zarzour Z D, Patterson S D, Johnson J A, King G J. Muscle forces and pronation stabilize the lateral ligament deficient elbow.  Clin Orthop Relat Res. 2001;  (388) 118-124
  • 22 Buchanan T S, Delp S L, Solbeck J A. Muscular resistance to varus and valgus loads at the elbow.  J Biomech Eng. 1998;  120(5) 634-639
  • 23 Johnson J A, Rath D A, Dunning C E, Roth S E, King G J. Simulation of elbow and forearm motion in vitro using a load controlled testing apparatus.  J Biomech. 2000;  33(5) 635-639
  • 24 Appelboam A, Reuben A D, Benger J R et al.. Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy in adults and children.  BMJ. 2008;  337 a2428
  • 25 Baumann E. Contributions to the knowledge of fractures about the elbow joint.  Bietrage Klin Chir. 1929;  146 1-50
  • 26 Williamson D M, Coates C J, Miller R K, Cole W G. Normal characteristics of the Baumann (humerocapitellar) angle: an aid in assessment of supracondylar fractures.  J Pediatr Orthop. 1992;  12(5) 636-639
  • 27 Donnelly L F, Klostermeier T T, Klosterman L A. Traumatic elbow effusions in pediatric patients: are occult fractures the rule?.  AJR Am J Roentgenol. 1998;  171(1) 243-245
  • 28 Swischuk L E, Hayden C K, Kupfer M C. Significance of intraarticular fluid without visible fracture in children.  AJR Am J Roentgenol. 1984;  142(6) 1261-1262
  • 29 Hall F M. Traumatic elbow effusions.  AJR Am J Roentgenol. 1999;  172(2) 550-551
  • 30 Griffith J F, Roebuck D J, Cheng J C et al.. Acute elbow trauma in children: spectrum of injury revealed by MR imaging not apparent on radiographs.  AJR Am J Roentgenol. 2001;  176(1) 53-60
  • 31 Major N M, Crawford S T. Elbow effusions in trauma in adults and children: is there an occult fracture?.  AJR Am J Roentgenol. 2002;  178(2) 413-418
  • 32 Greenspan A, Norman A. Radial head-capitellum view: an expanded imaging approach to elbow injury.  Radiology. 1987;  164(1) 272-274
  • 33 Mason M L. Some observations on fractures of the head of the radius with a review of one hundred cases.  Br J Surg. 1954;  42(172) 123-132
  • 34 Hotchkiss R N. Fractures and dislocations of the elbow. In: Rockwood CA Jr, Green DP, Bucholz RW, Heckman JD Rockwood and Green's Fractures in Adults. 4th ed. Philadelphia, PA; Lippincott-Raven 1996: 929-1024
  • 35 Gupta G G, Lucas G, Hahn D L. Biomechanical and computer analysis of radial head prostheses.  J Shoulder Elbow Surg. 1997;  6(1) 37-48
  • 36 Pribyl C R, Kester M A, Cook S D, Edmunds J O, Brunet M E. The effect of the radial head and prosthetic radial head replacement on resisting valgus stress at the elbow.  Orthopedics. 1986;  9(5) 723-726
  • 37 Jungbluth P, Frangen T M, Arens S, Muhr G, Kälicke T. The undiagnosed Essex-Lopresti injury.  J Bone Joint Surg Br. 2006;  88(12) 1629-1633
  • 38 Essex-Lopresti P. Fractures of the radial head with distal radio-ulnar dislocation; report of two cases.  J Bone Joint Surg Br. 1951;  33B(2) 244-247
  • 39 Edwards Jr G S, Jupiter J B. Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited.  Clin Orthop Relat Res. 1988;  (234) 61-69
  • 40 Regan W, Morrey B. Fractures of the coronoid process of the ulna.  J Bone Joint Surg Am. 1989;  71(9) 1348-1354
  • 41 Ring D, Jupiter J B, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid.  J Bone Joint Surg Am. 2002;  84-A(4) 547-551
  • 42 O'Driscoll S W, Jupiter J B, Cohen M S, Ring D, McKee M D. Difficult elbow fractures: pearls and pitfalls.  Instr Course Lect. 2003;  52 113-134
  • 43 Closkey R F, Goode J R, Kirschenbaum D, Cody R P. The role of the coronoid process in elbow stability. A biomechanical analysis of axial loading.  J Bone Joint Surg Am. 2000;  82-A(12) 1749-1753
  • 44 Beingessner D M, Dunning C E, Stacpoole R A, Johnson J A, King G J. The effect of coronoid fractures on elbow kinematics and stability.  Clin Biomech (Bristol, Avon). 2007;  22(2) 183-190
  • 45 Hull J R, Owen J R, Fern S E, Wayne J S, Boardman III N D. Role of the coronoid process in varus osteoarticular stability of the elbow.  J Shoulder Elbow Surg. 2005;  14(4) 441-446
  • 46 Ring D, Jupiter J B, Sanders R W, Mast J, Simpson N S. Transolecranon fracture-dislocation of the elbow.  J Orthop Trauma. 1997;  11(8) 545-550
  • 47 Broberg M A, Morrey B F. Results of treatment of fracture-dislocations of the elbow.  Clin Orthop Relat Res. 1987;  (216) 109-119
  • 48 Doornberg J N, Ring D C. Fracture of the anteromedial facet of the coronoid process.  J Bone Joint Surg Am. 2006;  88(10) 2216-2224
  • 49 Blasier R D. Intra-articular flap fracture of the olecranon in a child. A case report.  J Bone Joint Surg Am. 1989;  71(6) 945-947
  • 50 Bracq H. Fracture of the coronoid apophysis [in French].  Rev Chir Orthop Reparatrice Appar Mot. 1987;  73(6) 472-473
  • 51 Rommens P M, Küchle R, Schneider R U, Reuter M. Olecranon fractures in adults: factors influencing outcome.  Injury. 2004;  35(11) 1149-1157
  • 52 Morrey B F. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid.  Instr Course Lect. 1995;  44 175-185
  • 53 Hak D J, Golladay G J. Olecranon fractures: treatment options.  J Am Acad Orthop Surg. 2000;  8(4) 266-275
  • 54 An K N, Morrey B F, Chao E Y. The effect of partial removal of proximal ulna on elbow constraint.  Clin Orthop Relat Res. 1986;  (209) 270-279
  • 55 Jupiter J B, Mehne D K. Fractures of the distal humerus.  Orthopedics. 1992;  15(7) 825-833
  • 56 Ring D, Jupiter J B, Gulotta L. Articular fractures of the distal part of the humerus.  J Bone Joint Surg Am. 2003;  85-A(2) 232-238
  • 57 Doornberg J, Lindenhovius A, Kloen P, van Dijk C N, Zurakowski D, Ring D. Two- and three-dimensional computed tomography for the classification and management of distal humeral fractures. Evaluation of reliability and diagnostic accuracy.  J Bone Joint Surg Am. 2006;  88(8) 1795-1801
  • 58 Della-Giustina K, Della-Giustina D A. Emergency department evaluation and treatment of pediatric orthopedic injuries.  Emerg Med Clin North Am. 1999;  17(4) 895-922, vii
  • 59 John S D, Wherry K, Swischuk L E, Phillips W A. Improving detection of pediatric elbow fractures by understanding their mechanics.  Radiographics. 1996;  16(6) 1443-1460 quiz 1463-1464
  • 60 Rogers L F, Malave Jr S, White H, Tachdjian M O. Plastic bowing, torus and greenstick supracondylar fractures of the humerus: radiographic clues to obscure fractures of the elbow in children.  Radiology. 1978;  128(1) 145-150
  • 61 Carson S, Woolridge D P, Colletti J, Kilgore K. Pediatric upper extremity injuries.  Pediatr Clin North Am. 2006;  53(1) 41-67, v
  • 62 Baratz M, Micucci C, Sangimino M. Pediatric supracondylar humerus fractures.  Hand Clin. 2006;  22(1) 69-75
  • 63 Kasser J R. Supracondylar fractures in the distal humerus. In: Beaty JH, Kasser JR Fractures in Children. 5th ed. Philadelphia, PA; Lippincott Williams & Wilkins 2001: 577-624
  • 64 Wilkins K E. Fractures and dislocations of the elbow region. In: Rockwood CA Jr, Wilkins KE, King RE Fractures in Children. 3rd ed. Philadelphia, PA; Lippincott 1991: 526-617
  • 65 Skaggs D, Pershad J. Pediatric elbow trauma.  Pediatr Emerg Care. 1997;  13(6) 425-434
  • 66 Mirsky E C, Karas E H, Weiner L S. Lateral condyle fractures in children: evaluation of classification and treatment.  J Orthop Trauma. 1997;  11(2) 117-120
  • 67 Blane C E, Kling Jr T F, Andrews J C, DiPietro M A, Hensinger R N. Arthrography in the posttraumatic elbow in children.  AJR Am J Roentgenol. 1984;  143(1) 17-21
  • 68 Beltran J, Rosenberg Z S, Kawelblum M, Montes L, Bergman A G, Strongwater A. Pediatric elbow fractures: MRI evaluation.  Skeletal Radiol. 1994;  23(4) 277-281
  • 69 Vocke-Hell A K, Schmid A. Sonographic differentiation of stable and unstable lateral condyle fractures of the humerus in children.  J Pediatr Orthop B. 2001;  10(2) 138-141
  • 70 Lee H H, Shen H C, Chang J H, Lee C H, Wu S S. Operative treatment of displaced medial epicondyle fractures in children and adolescents.  J Shoulder Elbow Surg. 2005;  14(2) 178-185
  • 71 Kamath A F, Baldwin K, Horneff J, Hosalkar H S. Operative versus non-operative management of pediatric medial epicondyle fractures: a systematic review.  J Child Orthop. 2009;  3(5) 345-357
  • 72 Farsetti P, Potenza V, Caterini R, Ippolito E. Long-term results of treatment of fractures of the medial humeral epicondyle in children.  J Bone Joint Surg Am. 2001;  83-A(9) 1299-1305
  • 73 Fowles J V, Kassab M T, Moula T. Untreated intra-articular entrapment of the medial humeral epicondyle.  J Bone Joint Surg Br. 1984;  66(4) 562-565
  • 74 Boyette D P, London Jr A H. Subluxation of the head of the radius; nursemaid's elbow.  J Pediatr. 1948;  32(3) 278-281
  • 75 Salter R B, Zaltz C. Anatomic investigations of the mechanism of injury and pathologic anatomy of “pulled elbow” in young children.  Clin Orthop Relat Res. 1971;  77 134-143
  • 76 Mital M A. Congenital radioulnar synostosis and congenital dislocation of the radial head.  Orthop Clin North Am. 1976;  7(2) 375-383
  • 77 Slowik G M, Fitzimmons M, Rayhack J M. Closed elbow dislocation and brachial artery damage.  J Orthop Trauma. 1993;  7(6) 558-561
  • 78 Limb D, Hodkinson S L, Brown R F. Median nerve palsy after posterolateral elbow dislocation.  J Bone Joint Surg Br. 1994;  76(6) 987-988
  • 79 Mehlhoff T L, Noble P C, Bennett J B, Tullos H S. Simple dislocation of the elbow in the adult. Results after closed treatment.  J Bone Joint Surg Am. 1988;  70(2) 244-249
  • 80 Bruce H E, Harvey J P, Wilson Jr J C. Monteggia fractures.  J Bone Joint Surg Am. 1974;  56(8) 1563-1576
  • 81 Ring D, Jupiter J B, Simpson N S. Monteggia fractures in adults.  J Bone Joint Surg Am. 1998;  80(12) 1733-1744

Humberto G RosasM.D. 

Department of Radiology, University of Wisconsin School of Medicine and Public Health

University of Wisconsin Hospital and Clinics, F2/422, 600 Highland Ave., Madison, WI 53792

Email: hrosas@uwhealth.org

    >