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Elbow Effusions in Trauma in Adults and Children

Is There an Occult Fracture?

¹ Department of Radiology, Duke University Medical Center, Erwin Rd., Box 3808, Durham, NC 27710.
² Present address: Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., St. Louis, MO 63110.

View larger version (110K): [in a new window]   Fig. 1A. —5-year-old girl with fracture of medial epicondyle. Anteroposterior and lateral radiograph shows no fracture.

View larger version (111K): [in a new window]   Fig. 1B. —5-year-old girl with fracture of medial epicondyle. Lateral radiograph shows evidence of joint effusion.

View larger version (106K): [in a new window]   Fig. 1C. —5-year-old girl with fracture of medial epicondyle. Coronal fast spin-echo fat-suppressed T2-weighted MR image (TR/effective TE, 3500/65) shows high signal intensity in trochlea compatible with contusion (large arrow). Patient also has physeal injury that corresponds to Salter-Harris Type I fracture as shown by focus of high signal intensity seen along physis (small arrows).

View larger version (134K): [in a new window]   Fig. 2A. —10-year-old girl with radial head fracture. Anteroposterior radiograph shows no evidence of fracture.

View larger version (135K): [in a new window]   Fig. 2B. —10-year-old girl with radial head fracture. Coronal fast spin-echo fat-suppressed T2-weighted MR image (TR/effective TE, 3500/65) shows radial head fracture as evidenced by cortical disruption (arrow) and surrounding bone marrow edema.

View larger version (129K): [in a new window]   Fig. 2C. —10-year-old girl with radial head fracture. Consecutive posterior MR image shows linear high signal intensity located along fracture line (arrows).

View larger version (111K): [in a new window]   Fig. 3A. —80-year-old man with osteochondral fracture in capitellum. Anteroposterior radiograph shows no evidence of fracture.

View larger version (110K): [in a new window]   Fig. 3B. —80-year-old man with osteochondral fracture in capitellum. Coronal fast spin-echo fat-suppressed T2-weighted MR image (TR/effective TE, 3500/65) shows focal cartilage defect in capitellum with underlying marrow high signal intensity, consistent with osteochondral fracture (arrow). Defect should not be confused with "pseudodefect" of capitellum because abnormality is too anterior, and high signal intensity present around lesion would not be seen. Note remainder of images determined high signal intensity in radial shaft to be residual red marrow.

View larger version (95K): [in a new window]   Fig. 4A. —34-year-old man with osteochondral fracture in radial head. Anteroposterior radiograph shows no evidence of fracture.

View larger version (143K): [in a new window]   Fig. 4B. —34-year-old man with osteochondral fracture in radial head. T1-weighted coronal spin-echo MR image (TR/TE, 600/13) shows focal cartilage defect in radial head with surrounding marrow T1 shortening consistent with osteochondral fracture (arrow).

View larger version (103K): [in a new window]   Fig. 4C. —34-year-old man with osteochondral fracture in radial head. Coronal fast spin-echo fat-suppressed T2-weighted MR image (TR/effective TE, 3500/65) shows loose body in joint space from previously described osteochondral defect (arrow). Bone marrow edema is present in radial head.

View larger version (97K): [in a new window]   Fig. 5A. —26-year-old man with radial head fracture. Anteroposterior radiograph shows no evidence of fracture.

View larger version (143K): [in a new window]   Fig. 5B. —26-year-old man with radial head fracture. Coronal fast spin-echo fat-suppressed T2-weighted MR image (TR/effective TE, 3500/65) reveals radial head fracture shown by linear low signal intensity involving medial cortex of radial head (arrows) surrounded by bone marrow edema. High signal intensity in proximal ulna represents partial volume averaging with joint fluid.

View larger version (102K): [in a new window]   Fig. 6A. —65-year-old man with nondisplaced medial epicondyle avulsion and coronoid process fracture with extensor tendon complex injury from lateral epicondyle. Anteroposterior radiograph shows no evidence of fracture.

View larger version (136K): [in a new window]   Fig. 6B. —65-year-old man with nondisplaced medial epicondyle avulsion and coronoid process fracture with extensor tendon complex injury from lateral epicondyle. Coronal fast spin-echo fat-suppressed T2-weighted MR image (TR/effective TE, 3500/65) shows high signal at olecranon process (small arrow). In addition, bone marrow edema is seen in lateral epicondyle (large arrow). Common tendon of wrist-hand extensor-supinator complex has been avulsed from its origin (curved arrow).

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