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August 2008 Radiology Quiz
This patient is a 10 year old female who presents to the ED with the complaint of left elbow pain after a fall. The following x ray is shown.
Questions:
1. Describe what you see?
2. What is the Anterior Humeral Line?
- The anterior humeral line is obtained by extending a line along the anterior humeral cortex on a true lateral radiograph with the elbow flexed to 90 degrees (double-headed arrow). Normally, this line will pass through the middle one third of the capitellum. The elevated anterior fat pad producing the sail sign (arrowheads) and the clearly visible posterior fat pad (straight arrow) necessitate a careful search for a subtle fracture of the radial head (curved arrow) in a skeletally mature patient. (See picture below)
3. What is the most common cause for this injury?
- The most common mechanism is a fall on the outstretched hand.
4. What would be your management for this patient?
- Nondisplaced fractures are treated with sling immobilization. Followed by early range of motion exercises as tolerated. Comminuted and displaced fractures are treated with immobilization in a long arm posterior splint and early orthopedic referral for screw fixation or radial head excision if one of the following exists:
- A. Angulation of the articular surface that is greater then 30 degrees
- B. Marked comminution of the fracture
- C. Greater then a 2mm offset in a two part fracture
- D. Fracture involving more than one third of the articular surface.
5. What is a somato-somatic reflex?
- A somatic dysfunction that produces a stimulus that may generate a secondary somatic dysfunction elsewhere.
Trivia: What Beach Boy song, written by Brian Wilson, did Paul McCartney refer to as "the most beautiful song ever written"?
- A: "God Only Knows" from the "Pet Sounds" album
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