肘关节损伤X线平片阅读技巧Word文档格式.docx
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肘关节损伤X线平片阅读技巧Word文档格式.docx
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Searchforanadequate"
hourglasssign"
or"
figureofeight"
atthedistalhumerus.Ifabsentthestudyisnotatruelateralandinterpretationofsteps2through4islessreliable.
Here'
sanexampleofatruelateral;
notethesymmetricfigureofeight/hourglasssignatthedistalhumerus;
alsonoticetheposteriorfatpad?
(seebelow.)
HereisanimperfectlateralradiographaccompaniedbyanormalAPradiograph;
noticehowthefigureofeight/hourglassisasymmetric:
Step2:
anteriorfatpadevaluation
Avisibleanteriorfatpadcanbenormal;
itisasmallradiolucentshadowadherenttotheanterioraspectofthedistalhumerus:
Anabnormalanteriorfatpadisdescribedasa"
sailsign"
becauseitisunusuallyprominentandbowsoutwardtoformatriangularshape.Aftertrauma,bloodcanaccumulateintheintraarticularspaceandpushthefatpadanteriorly;
apositivesailsigninthesettingoftraumaisareliableindicationofanintraarticularfracture–evenifnofracturelinecanbeidentified.Anatraumaticsailsignimpliesintraarticularfluidofaninflammatorynature.
Step3:
posteriorfatevaluation
Radiographicvisualizationofaposteriorfatpadisnevernormalandalwayssignifiesfluidintheintraarticularspace.Again,inthesettingoftrauma,thisstronglyimpliesfractureofanarticularsurface.
Hereisaradiographwithbothasailandposteriorfatpadsign:
Step4:
anteriorhumeralline
Thislineshouldintersectthemiddlethirdofthecapitellumonthelateralview.Fracturesusuallyresultindisplacementofthecapitellumposteriorly(versusanteriorly).Ifthefilmisnotatruelateral,interpretationoftheanteriorhumerallinebecomesfallible.
Thisradiographdepictsanormalanteriorhumeralline:
Step5:
radio-capitellarline
Thislineisdrawnthroughthemiddleoftheradiusposteriorly/rostrallyandshouldbisectthecapitellumonboththelateralandtheAPelbowradiograph.Failuretoalignproperlyindicatesaradialheaddislocationthatrequirespromptreductionifneuro-vascularcompromiseistobeavoided.
Step6:
inspectionoftheradialhead
Carefulinspectionisparamountsincefracturelinesareoftennotvisible;
lookforsubtledisruptionsinthecorticalcontour.Examinetheradiographbelow:
Noticehowtheradiusbisectsthecapitellumonthisview;
howeverthereisasubtlecorticaldisruption/acuteangulationatthesuperioraspectofthedistalradiusindicatingfracture.
Normalradio-capitellarlines:
Noticethatthisisnotanideallateralmakinginterpretationoftheanteriorhumerallinedifficult;
howevertheradiusshouldbisectthecapitellumonallviewsregardlessofadequacy;
alsonotetheposteriorfatpad.
Anabnormalradio-capitellarlineisdepictedbelow:
Onbothviewstheradiusfailstobisectthecapitellumindicatinganobviousradialheaddislocation.Alsonotetheanteriorandposteriorfatpads,aswellastheobviousolecranondeformity.AradialheaddislocationwithanolecranonfractureiscalledaMonteggiainjury.
Thisradiographdemonstratesabnormalalignmentoftheanteriorhumerallinestronglysuspiciousforfracture.(Theanteriorhumerallineofatoddler/childmustalsointersectthemiddlethirdofanossifiedcapitellum;
alsonotetheposteriorfatpadandsailsign.)
Step7:
distalhumerusexamination
Signsofhumeralfracturearealsocommonlysubtle;
breakagemayonlybeevidencedbyanabnormalanteriorhumeralline.Examtheradiographbelow:
Theanteriorhumerallineisperhapsslightlyoffasitseemstointersecttheanteriorthirdofthecapitellum,whiletheradio-capitellarlineisintact.Thereareprominentsailandposteriorfatpadsigns;
andoncarefulinspectiononeseesthesubtlecorticaldisruptionalongtheposterioraspectofthedistalhumerus.
Step8:
Lookforobviousfracturelinesandsubtledisruptionsincorticalcontour.
Thisisnotagoodlateralradiographsointerpretationoftheanteriorhumerallineisunreliable.Thereisnoobviousanteriororposteriorfatpad,andtheradio-capitellarlineisintact.Theradialheadanddistalhumerusappearfine,whilethereisanobviousproximalolecranonfracture.
andoncarefulinspectiononeseesthesubtlecorticaldisruptionalongtheposterioraspectofthedistalhumerus.
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