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Acute Elbow Trauma in Children

Spectrum of Injury Revealed by MR Imaging Not Apparent on Radiographs

¹ Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Sha Tin, Hong Kong.
² Present address: Department of Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom.
³ Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Sha Tin, Hong Kong.
⁴ Department of Accident and Emergency Medicine, Chinese University of Hong Kong, Sha Tin, Hong Kong.

View larger version (122K): [in a new window]   Fig. 1A. —10-year-old boy with acute elbow trauma sustained during fall. Lateral radiograph of elbow shows undisplaced anterior fat pad (arrow) and no posterior fat pad. No fracture is visible.

View larger version (92K): [in a new window]   Fig. 2A. —6-year-old boy with acute elbow trauma sustained during fall. Radiograph of elbow shows joint effusion, but it does not reveal fracture.

View larger version (108K): [in a new window]   Fig. 3A. —10-year-old boy with acute elbow trauma sustained during fall. Anteroposterior radiograph of elbow shows fracture (arrow) of lateral humeral condyle. Note normal appearance of capitulum.

View larger version (109K): [in a new window]   Fig. 2B. —6-year-old boy with acute elbow trauma sustained during fall. Sagittal T2-weighted short tau inversion-recovery MR image of elbow shows widening of physis as hyperintense band (arrow) extending between metaphysis and hypointense unossified cartilage.

View larger version (144K): [in a new window]   Fig. 3B. —10-year-old boy with acute elbow trauma sustained during fall. Gradient-recalled echo coronal MR image of humerus shows fracture (arrow) of lateral condyle.

View larger version (138K): [in a new window]   Fig. 3C. —10-year-old boy with acute elbow trauma sustained during fall. Gradient-recalled echo coronal MR image obtained more anterior to B shows fracture (arrow) extending through capitulum and unossified cartilage.

View larger version (167K): [in a new window]   Fig. 4B. —10-year-old boy with acute elbow trauma sustained during fall from bicycle. Sagittal T2-weighted short tau inversion-recovery (STIR) MR image of elbow shows large hemarthrosis with muscle edema of triceps (white arrow), bone bruising of ulna (black arrow), and subcutaneous edema.

View larger version (150K): [in a new window]   Fig. 5. —5-year-old boy with acute elbow trauma sustained during fall. Axial T2-weighted short tau inversion-recovery image through proximal forearm shows thin rim of hyperintensity around proximal radius (R) that is consistent with annular ligament injury (arrows). Additional sagittal images allowed differentiation of annular ligament injury from fluid surrounding proximal radius. U = ulna.

View larger version (131K): [in a new window]   Fig. 6. —11-year-old boy with prior elbow dislocation. Coronal T2-weighted short tau inversion-recovery MR image of elbow shows discontinuity (arrow) of lateral collateral ligament.

View larger version (153K): [in a new window]   Fig. 7. —10-year-old boy with elbow injury sustained during fall. Sagittal T2-weighted short tau inversion-recovery MR image of elbow shows edema of brachialis and triceps muscles. Bone bruising of ulna and hemarthrosis are also present.

View larger version (151K): [in a new window]   Fig. 1B. —10-year-old boy with acute elbow trauma sustained during fall. Sagittal T2-weighted short tau inversion-recovery MR image of elbow shows undisplaced fracture of proximal radial metaphysis (arrow). Bone bruising of proximal radius adjacent to fracture can be seen. Note absence of significant joint effusion.

View larger version (119K): [in a new window]   Fig. 4A. —10-year-old boy with acute elbow trauma sustained during fall from bicycle. Lateral radiograph of elbow shows large joint effusion. No fracture is visible.

View larger version (124K): [in a new window]   Fig. 4C. —10-year-old boy with acute elbow trauma sustained during fall from bicycle. Axial T2-weighted STIR MR image of proximal forearm shows fracture (arrow) of radial head.

View larger version (122K): [in a new window]   Fig. 8. —9-year-old boy with acute elbow trauma sustained during fall. Sagittal T2-weighted MR image shows metaphyseal fracture (arrow) with widening of adjacent growth plate.

View larger version (139K): [in a new window]   Fig. 9. —7-year-old girl with acute elbow injury sustained during fall. Axial T2-weighted short tau inversion-recovery MR image of proximal forearm shows edema of supinator muscle (arrows). R = radius, U = ulna.

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