Imaging (Contours)

Finally, it is important to analyse all three bones of the elbow joint and follow the contours, looking for irregularities and steps that could indicate subtle disruptions and fractures in the cortex.

Common subtle injuries that may be difficult to identify include undisplaced radial head fractures in adults and undisplaced supracondylar fractures in children. There may often be other clues such as a positive fat pad sign (click on the x-ray to enlarge).

Clearly, the x-ray is an adjunct to your assessment and management should be based on clinical findings and suspicion, rather than x-ray appearances alone.

Whenever a fracture is identified it is essential that the ipsilateral wrist is imaged along with the entire radius and ulna, in order to exclude any associated fractures or dislocations.

Learning bite

It is important to interpret the x-ray in combination with examination findings.
The identification of a bony injury should prompt a search for other associated injuries. This may require additional imaging.