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Question: Elbow Trauma
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Which of the following elbow radiography findings can be normal in a 2 year old that fell on an outstretched arm and has decreased use of her elbow?
Kelly March 18, 2019 - 12:20 am
B) Anterior fat pad
PEM Playbook has an outstanding podcast and show notes on pediatric elbow injuries at http://pemplaybook.org/podcast/pediatric-elbow-injuries/ A posterior fat pad is never considered normal on ED films as it may represent an occult fracture. An anterior fat pad can be normal if close to the humerus, but is abnormal if significantly pushed outwards (“sail sign”). The ossification centers appear in order using the CRITOE mnemonic: capitellum, radial head, internal (medial) condyle, trochlea, olecranon, external (lateral) condyle – therefore, would not expect to see C, R, E without the intervening ossification centers also present. The anterior humeral line on lateral view should bisect the capitellum.