SET T0021 -
Emergency Department

Normal radiograph. The fat pads are not raised. No adverse finding.

All of the ossification centres are in their normal positions. The fragmented ossification of the lateral epicondyle is a common normal variant.

Avulsion fracture of the medial epicondyle. The epicondyle is displaced and rotated.

The lateral radiograph is very abnormal.

The findings: raised anterior and posterior fat pads, indicating a large effusion at the elbow joint.

The anterior humeral line breaks the " at least 1/3rd in front " rule.

Diagnosis: supracondylar fracture with posterior displacement.

An abnormal anterior humeral line . . .

See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 101 and 106-108

Don't send home. Call the Orthopaedic team.

The medial epicondyle has been avulsed from its normal position and it (red circle) is now situated in the joint.

This will need restoration of the normal anatomy with fixation of the medial epicondyle.

NB On the CRITOL evaluation - there is no " I " in the expected anatomical position on this AP radiograph.

No " I " in the expected anatomical position??

See : Accident & Emergency Radiology : A Survival Guide (3rd edition) : Pages 98-100,105