Traumatic Elbow Mediolateral Investigatory Screening: The value of the sitting axial mediolateral projection in the diagnosis of radial head fractures

Abstract

Background: Elbow injuries are frequently encountered in hospital practice, while radial head fractures are the commonest result of such trauma. Diagnosis of radial head fractures is based on clinical and radiographic evaluation with a number of X-ray projections being available. A combination of views is chosen, comprising of routine elbow series screenings and modified techniques, as well as the assistance of the fat-pat sign; never the less fractures can still be occult on X-rays. Purpose: This article aims to demonstrate the diagnostic value of the sitting axial mediolateral projection, which in our hospital is referred to as the Traumatic Elbow Mediolateral Investigatory Screening (TEMIS). This projection has been successfully used in our hospital repeatedly for the identification of occult fractures that were missed by other projections. Materials and methods: 62 patients who presented to our Emergency Department due to trauma in the elbow over a six-month period were X-rayed for the identification of fractures. Projections included an anteroposterior, a lateral and TEMIS. Results: Radial head fractures (Mason type I) were identified in 14 out of 62 patients. 2 of these were only visible on the TEMIS projection, while they were missed by the other two views. Conclusion: Trauma to the elbow is a common type of injury. Minor fractures can be expected to heal with good results; complications, however, should not be underestimated. Improper healing can result in a permanently malfunctioning joint with restricted movement and stiffness. To avoid such consequences the choice of a reliable screening projection is significant. In our case the diagnostic value of the TEMIS projection lies in the fact that it shows all fractures seen on routine screenings and reveals fractures missed by them, also being well tolerated by patients due to comfortable arm placement during the screening. All in all, when a fracture is suspected on the basis of clinical signs but no radiographic evidence is seen on conventional screenings, the TEMIS view is recommended for further investigation.