Eccentric Capitellar Ossification Limits the Utility of the Radiocapitellar Line in Young Children

Fader, Lauren; Laor, Tal; Eismann, Emily A.; Cornwall, Roger; Little, Kevin J.

doi:10.1097/bpo.0000000000000426

Cited by 23 publications

(16 citation statements)

References 23 publications

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“…The model also showed that skeletal age affected the accuracy of the radiocapitellar line in males, with the line being more accurate as skeletal age increases. This shows that skeletal age, not chronological age [19], influenced the accuracy of the line, although there was no cut-off for age in our study where thereafter the line reliably bisected the capitellum, and our results were only limited to the male population.…”

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 93%

“…Ossification of the capitellum occurs from medial to lateral and is influenced by age and sex too. The eccentric nature of the ossification pattern of capitellum makes the reliability of the radiocapitellar line limited at a younger age, with the radiocapitellar line only reliably bisecting the capitellum after 10 years in girls and 11 years in boys [19]. This is supported by Kunkel et al where one-tenth of radiocapitellar lines missed the capitellum in normal patients aged 3 and younger [16], and Ramirez et al showing that the line moves further away from the center of the capitellum with decreasing age, leading to over 16% of lines missing the capitellum in normal individuals [20].…”

Section: Discussionmentioning

confidence: 99%

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Using the radiocoronoid line for diagnosis of elbow dislocation

Tan

Tan²,

Tay³

et al. 2022

Journal of Pediatric Orthopaedics B

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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.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Using the radiocoronoid line for diagnosis of elbow dislocation

Tan

Tan²,

Tay³

et al. 2022

Journal of Pediatric Orthopaedics B

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“…Studies proved that in children with not fully ossified elbow joint, RCL misses capitulum in its middle third in up to 80% of cases and entirely in up to 17% of cases. 4 – 7 These studies also proved that RCL drawn through the neck of the radius is more accurate than the line drawn through the shaft. 3 , 4 This accentuates in younger children, which has been proven in this study, as only four of our patients from the group with suspected dislocation of the humeroradial joint were older than 10 years, and half of them (18) were younger than 6 years.…”

Section: Discussionmentioning

confidence: 70%

“…3,4 Despite regular use of RCL in diagnostics of the dislocation of the proximal radius, it has been proven that in younger children with unfinished ossification of the elbow, RCL misses the capitulum in its middle third or entirely. [3][4][5][6][7] This results mainly from the eccentric ossification of the capitulum and limits the use of RCL in assessing the humeroradial joint in younger children. If there is any doubt, a child with suspected dislocation of the proximal radius usually undergoes repeated X-rays and/or manipulation under an X-ray amplifier under general anesthesia to confirm the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound imaging in diagnostics of Monteggia lesion in children

Cepelik

Hendrych

Melínová

et al. 2022

Journal of Children's Orthopaedics

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Purpose: The aim of the study is to evaluate the use of ultrasound imaging in diagnostics of Monteggia lesion in children where conventional radiographs and the use of the radiocapitellar line fail to provide an accurate diagnosis. Methods: Prospective diagnostic study of 70 patients treated between May 2018 and July 2021 in a pediatric level 1 trauma center. In 20 patients with the confirmed radiographic diagnosis of Monteggia lesion, an ultrasound of the humeroradial joint was performed to determine signs of both normal and dislocated elbow joint. In 36 patients with suspected humeroradial dislocation on plain radiographs, ultrasound imaging was performed to determine the definitive diagnosis. Overall, 14 patients with elbow joint injury other than humeroradial dislocation were excluded from the study. Results: The “double-hump sign” and the “congruency sign” were determined as normal findings on ultrasound of the humeroradial joint. These signs were applied to patients with unclear findings on radiographs. In three patients, the dislocation of the humeroradial joint was confirmed by ultrasound. In two patients, “defect in congruency sign” was seen during reduction despite normal radiographs, which required re-reduction. In 31 patients, dislocation of the humeroradial joint was refuted. In 34 out of the 36 patients, the diagnosis determined by ultrasound was confirmed in follow-up. Two patients did not attend the follow-up examination. Conclusion: Ultrasound imaging is an accessible, non-invasive, and dynamic point-of-care method that can be applied in children suffering from suspected humeroradial dislocation and/or subluxation. Level of evidence: Level III—diagnostic study.

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Chronic Monteggia Injuries

Soldado

Kozin

2018

Pediatric Elbow Fractures

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Eccentric Capitellar Ossification Limits the Utility of the Radiocapitellar Line in Young Children

Cited by 23 publications

References 23 publications

Using the radiocoronoid line for diagnosis of elbow dislocation

Using the radiocoronoid line for diagnosis of elbow dislocation

Ultrasound imaging in diagnostics of Monteggia lesion in children

Chronic Monteggia Injuries

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