PAEDIATRIC ELBOWS Anterior fat pad Normal appearance on

PAEDIATRIC ELBOWS Anterior fat pad – Normal appearance on X ray – Abnormal if displaced = “Sail Sign”go fishing for the fracture Posterior fat pad - Not visible on normal X ray - Always abnormal if visible – find the fracture

Anterior Humeral Line Should pass through middle third of capitellum – if not, think Supracondylar #

Radiocapitallar Line A line through the centre of the radial neck should pass through the centre of the capitellum whatever the orientation of X ray or positioning of patient - if not, think Dislocated radial head (often with ulnar shaft # = Monteggia)

6 months C R I T O E 12 Years R

The Critoe Rule If you can see a Trochlea 6 months C apitellum R adial Head I Look for the Internal Epicondyle It may be avulsed and displaced, sometimes as part of a dislocated elbow (that may have reduced prior to presentation) nternal Epicondyle T rochlea O lecranon E xternal Epicondyle 12 Years

Lots of soft tissue swelling indicates the elbow has been dislocated (blue arrows) So the next question is where is the Internal (medial) epicondyle? It is seen entrapped within the joint There is only minor joint effusion (asterix*) probably due to prior dislocation. The internal epicondyle is extra-articular & avulsion alone will not produce joint effusion