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E1218. Adult Traumatic Elbow Injuries: Classifications and Management
Authors
  1. Mindy Wang; University of Texas at Houston
  2. Nicholas Beckmann; University of Texas at Houston
Background
Traumatic elbow injuries are relatively rare, although commonly encountered in the emergency department setting. They are most frequently seen as the result of falls on an outstretched hand. Due to their rarity, most radiologists are unfamiliar with the injury patterns and classifications systems associated with elbow trauma. The purpose of this presentation is to review the common adult elbow traumatic injury patterns, classification systems, and imaging findings that are indications for surgical management. Appropriate diagnosis and timely management are essential to prevent potential poor functional outcomes and chronic joint instability.

Educational Goals / Teaching Points
The educational goals of this exhibit are to review the normal elbow alignment and anatomy, describe and depict common adult traumatic elbow injury patterns, discuss commonly used injury classifications in elbow trauma, and highlight imaging findings that influence their surgical management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The normal elbow anatomy will be reviewed with 3D volume rendered computed tomography (CT) images and magnetic resonance imaging (MRI), along with line drawings. While radiographs universally help with initial diagnosis, CT and MRI can aid with further characterization of bony and soft tissue abnormalities. We will provide an anatomy-based review of commonly encountered elbow fractures in adults, their classification systems, and important imaging features that affect surgical management. Distal humeral fractures will be reviewed using the AO Foundation/Orthopedic Trauma Association (AO/OTA) classification, the Milch classification for single column fractures, and the Juniper classification for column fractures. These classifications underscore important characteristics of distal humeral fractures: articular and columnar involvement and the degree of comminution. Radial head and neck fractures are the most common elbow injury in adults. The Mason classification for radial head fracture emphasizes the degree of displacement, percent of articular surface involvement, and associated comminution or dislocation. Osseous ring injury patterns involving the proximal radius include Essex-Lopresti and Monteggia fractures. Olecranon fractures are characterized by their degree of displacement and presence of comminution, which is highlighted by the Schatzker classification. The Regan-Morrey classification helps define the percentage of coronoid process involvement in the horizontal plane. Common avulsion fractures of the elbow and elbow instability patterns, including posteromedial rotatory instability, posterolateral rotatory instability, and dislocations, will be reviewed. Early identification of instability patterns is critical for prompt treatment.

Conclusion
Traumatic elbow injuries are relatively rare compared with other traumatic joint injuries, but can result in significant morbidity if left untreated. Understanding the common elbow injury patterns, classification systems for injuries, and imaging indications for surgery can help radiologists both identify injuries as well as describe injuries in a clinically meaningful manner.