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January 2005
By Theodore E . Keats, MD
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This six-year-old child injured her elbow. What is
your interpretation of these frontal and lateral projections
of her elbow?
CLICK HERE FOR ANSWER
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ANSWER
The correct diagnosis is transcondylar fracture of
the humerus. Striking fat pad displacements are evident
in the lateral projection, indicating intracapsular
bleeding. In addition, the line along the anterior aspect
of the humerus (anterior humeral line) in the lateral
projection should intersect the middle third of the
ossification of the capitellum. In this case, it crosses
the anterior third. This finding indicates posterior
displacement of the entire articular portion of the
distal humerus, thus a transcondylar fracture. These
fractures are often difficult to detect and the anterior
humeral line is therefore an important clue.
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This series of diagnostic quizzes that
challenge your ability to read a variety of X-ray films is
edited by Dr. Keats, alumni professor of radiology at the
University of Virginia School of Medicine in Charlottesville.
Emerg Med 37(1):51, 2005
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