The radiocapitellar line (RCL) has been widely used to diagnose elbow dislocation. However, there are limitations to the RCL, with the cartilaginous portion of bone making interpretation of radiographs difficult. The study aims to show that the radiocoronoid line, which connects two points on the medial aspect of the radius, proximal to the radial tuberosity, is more suited to diagnose elbow dislocations in the anterior-posterior projection. This study also observes factors affecting accuracy of the radiocapitellar line. The radiographs of 50 normal and 17 laterally dislocated elbows were obtained. An unbiased independent reviewer drew the radiocoronoid and radiocapitellar line (RCL). Four other blinded independent reviewers drew the RCL and the radiocoronoid line for 20 radiographs and repeated the process a week later. The accuracy of the RCL was assessed using distance away from bisection point of capitellum, and ratio (distance from the point where line crosses capitellum to lateral aspect of capitellum over the total width of capitellum). The relationship of the radio-coronoid line and the lateral aspect of coronoid fossa was assessed, with dislocation being the line lateral to it and normal being medial to or on it. The radiocoronoid line had a higher accuracy (95.5%) compared to RCL (32.8%), higher specificity (94%) compared to RCL (10%) as well as higher positive predictive value (85%) compared to RCL (27.4%). There was no intra- or inter-observer variability for the radio-coronoid line. Skeletal age statistically predicted the ratio for the male population (P < 0.05), however, the independent variables did not statistically predict the dependent variables for the female and total population. The radiocoronoid line serves as an additional method to assess radiocapitellar joint lateral dislocation. It is more accurate and reliable than the radiocapitellar line in the anterior-posterior projection. Sex and skeletal age also influence the accuracy of the radiocapitellar line with the radiocapitellar line nearing the bisection point as skeletal age in males increases.

Paediatric forearm fractures are extremely common among children. Surgical treatment instead of casting is necessitated in highly unstable forearm fractures. A widely accepted technique of operative fixation today is via the elastic stable intramedullary nail (ESIN), which was first introduced in 1977. Closed reduction with the ESIN is often attempted first, failure of which may warrant the need for open reduction. However, multiple attempts at closed reduction not only increase the incidence of tissue trauma but also lead to severe postoperative complications such as compartment syndrome. Yet, little information exists to help surgeons anticipate when a child is more likely to require an open reduction. This study aims to determine certain risk factors that would point toward a greater likelihood of open reduction, and thus help surgeons avoid too many unnecessary endeavors at closed reduction. A total of 144 cases of forearm fractures fixated using ESINs between 2014 and 2019 were retrospectively identified in the institution of study. Patient factors, fracture characteristics and surgery details were also gathered from the institution’s database. Statistical analysis was performed using SPSS and comparison was then done between the two groups of patients who underwent closed and open reductions. Results showed that the statistically significant risk factors for predicting unsuccessful closed reduction in forearm fractures were the amount of fractured bone overlap at presentation (P < 0.001) and whether the bones were fractured at different levels (P = 0.032). Other variables examined, including the patient’s biological age, skeletal age, BMI, fractured bone-angulation, site of fracture, fracture pattern and surgical circumstances did not contribute to differentiating between the likelihood of a closed versus open reduction. Children with a higher degree of fractured bone overlap at presentation or if the radius and ulnar bones were fractured at different levels, should be adequately forewarned regarding the increased chances of conversion to an open reduction. Surgeons should also avoid excessive attempts at closed reduction of forearm fractures with the ESIN in such circumstances. Level of Evidence: Level IV.