Joseph McGinley MS, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Elbow injuries are a common entity, representing five to eight percent of all adult fractures. Large displaced fractures within the elbow, easily identified on radiographs, typically result in severe pain and a reduced range of motion. Small non-displaced fractures however, typically do not disrupt normal motion and are more difficult to diagnose. The purpose of this study was to determine the sensitivity and specificity of radiography in identifying non-displaced elbow fractures. Methods and Materials: A double-blinded study utilizing 16 cadaver arms was designed simulating forearm trauma in an in-vitro model. Axial impact loads were applied to the distal radius with each arm in full extension and forearm rotation varied from pronation to supination. Following injury, AP and lateral radiographs were obtained in the standard fashion to examine the elbow. Each specimen was then dissected and the type of elbow injury fully described by a blinded investigator. Specifically, the radial head, olecrenon and the coronoid process were examined for fractures. The radiographs were examined by a blinded radiologist and the results were compared to the dissections. The sensitivity, specificity, positive predictive value and negative predictive value of radiography were determined with the dissection results as the standard. Results: Dissection results revealed five displaced/comminuted radial head fractures, three non-displaced radial head fractures and eight intact specimens. Radiographs identified all of the displaced radial head injuries, while the non-displaced fractures were diagnosed as intact. Similar findings were demonstrated for the olecrenon, coronoid process and radial neck. Overall radiography of all non-displaced fractures within the elbow demonstrated a sensitivity of 20%, a specificity of 85%, a positive predictive value of 25% and a negative predictive value of 81%. Conclusion: Radiography for non-displaced elbow fractures demonstrated limited success in this study. Our results suggest that additional studies or alternative viewing plains may be required in the cases of suspected elbow injuries with initial negative films. However, when a diagnosis of a non-displaced fracture was made, the specificity of the study was high. This study also showed that the diagnosis of displaced elbow fractures was highly accurate with radiographs. Clinically, a negative diagnosis with a highly suspicious injury requires further evaluation.       Questions about this event email: mcginleyjoseph@hotmail.com

McGinley MS, J, Non-Displaced Fractures of the Elbow: Are We Missing the Diagnosis?.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3102185.html