Image Interpretation - Adult Elbow
(The paediatric elbow differs completely)
1) Name, DOB, Hospital Number
2) Clinical information, Mechanism of Injury (this can hint at the type of fracture expected to see)
3) Technical Quality
- Anatomical marker present? (If so, is it the correct marker?)
- Adequate contrast?
- Adequate density?
- Area of Interest included?
4) Start with the lateral
- Check for a raised anterior fat pad (visualisation of a non-raised anterior fat pad can be normal. A raised anterior fat pad [SAIL sign] is abnormal).
- Check for a posterior fat pad (visualisation of a posterior fat pad is always abnormal and indicates a fracture).
NB: Just because there is no raised or presence of fats pads does not mean there is no fracture. A patient who had trauma 3 or 4 weeks ago may very well have a fracture, however the joint effusion may have subsided by now. Always ask how long ago the trauma was.
- Check the Radiocapitellar line (?dislocation)
- Check the Anterior Humeral Line (?supracondylar fracture [mainly paeds, rarely adults]).
- Trace round the radial head (most common adult fracture)
- Trace around the distal humerus and proximal radius/ulna for fractures.
- Trace around olecranon (these fractures are usually quite obvious).
5) AP Projection
- Trace round radial head.
- Check medial and lateral condyles (?avulsion fracture).
- Check olecranon.
- Trace round distal humerus and radius/ulna for fractures.
Describing the fracture:
E.g: There is a fracture through the radial head of the left elbow with associated raised anterior fat pad (anterior sail sign) and the presence of a posterior fat pad. This indicates a joint effusion.
- If a marker is present and it is correct, state the side in the report. If no marker is present, state “No anatomical marker present on film. Based on radiographic technique and anatomy is it presumed that this is a left elbow, however this can not be confirmed. Clinical correlation should confirm side prior to treatment.”.
- If the wrong anatomical marker is present, state “It is assumed that based on radiographic technique and anatomy that this is a left elbow. However, a right anatomical marker is present. Clinical correlation should confirm side prior to treatment.”.
In basic, SAY WHAT YOU SEE. Develop a protocol for each body part that you follow that assess the whole film, including technical quality, area of anatomy included and pathology.
Rads/Doctors/Radiologists out there who care to add/help/change anything, feeel free to comment and help us out! Jamie (TheNext3Years).
Note: This is how I check an elbow film. It has come of 3 years of university education and teaching from clinical placements, senior Radiographers and text books I have read over the years. Remember, I’m just a junior diagnostic radiographer and not qualified to report. This is just some helpful advice for assessing a film.
Images from WikiRadiography