Traumatic Elbow Swelling
This 5 year old presented to ED with elbow pain and swelling after falling onto his left outstretched arm. The XR is shown.
Questions
What is the abnormality?
Answer
expand(document.getElementById('ddet106471959'));expand(document.getElementById('ddetlink106471959'))
Supracondylar fracture
There is a posterior fat pad.
Anterior fat pads are normal, although a large anterior fat pad (based on subjective judgement) can be abnormal (sail sign).
The mantra goes that posterior fat pads are always abnormal – 75% of them have fractures.
Fat pads generally demonstrate intra-articular disruption.
How do you grade this injury?
Answer
expand(document.getElementById('ddet812279664'));expand(document.getElementById('ddetlink812279664'))
Gartland I supracondylar fracture.
The posterior fat pad and the history indicate a likely supracondylar fracture. These are the most common elbow injuries in kids between 5 and 8 years.
Some can have anterior displacement of the distal humerus (flexion-type) but most are extension-type injuries.
The anterior humeral line should go through the middle third of the capitellum. If it doesn’t then this indicates displacement.
AP views are also helpful but in a Gartland I often there will be no fracture visible on AP.
Gartland Classification
Gartland I – no displacement
Gartland II – posterior displacement of the distal end of the humerus but with intact cortex (image 3)
Gartland III – complete displacement
Gartland II
expand(document.g...
Source: Life in the Fast Lane - Category: Emergency Medicine Doctors Authors: Tessa Davis Tags: Emergency Medicine Featured Orthopedics Pediatrics Elbow fracture paediatrics supracondylar fracture Trauma X-Ray Source Type: blogs