（优质医学）儿童肘关节读片.ppt

* Right: Olecranon fracture indicated by discontinuity of the dorsal cortex. No associated fracture. Left: Normal olecranon ossification centres in a patient with a tilted radial neck fracture. * some examples of fractures of the olecranon. Notice how subtle some of these fractures are. * * Separate ossification centres for the olecranon in an adolescent boy (arrowheads) * FIGURE 6-92 A separate nucleus of ossification for the olecranon process, not a fracture. (Ref: Silberstein MJ, et al: Some vagaries of the olecranon. J Bone Joint Surg Am 63:722, 1981.) * FIGURE 6-93 Other examples of separate apical nuclei of ossification for the olecranon process. * Normal apparent separation of the ossification centre for the lateral epicondyle (arrow) * Fusion of the ossification centre for the lateral epicondyle with the capitellum prior to closure (arrow) * * * * * * * * Humero-ulnar angle: line along the long axis of the humerus (A) and the long axis of the ulna (B), the angle is measured on the medial side. This angle depicts the carrying angle of the elbow. This ranges from 154°–178° and is greater in females (Keats et al. 1966). * This angle is subtended by the longitudinal axis of the humerus and a line through the coronal axis of the capitellar epiphysis. This angle has a mean value of 70° (range 64°–81°) (Williamson et al. 1992). The wrist should be higher than the elbow to compensate for the normal valgus position of the elbow. The hand should be with the thumb up’. * LEFT: Slight endorotation of the humerus due to a low position of the wrist. RIGHT: More endorotation due to malpositioning. * * Presence of an anterior fat pad is normal. However if it is triangular or sail shaped it is abnormal. Appears as radiolucency between bony rim of coronoid fossa and moderately radioopaque brachialis muscle When pathology exists anterior fat pad is pushed anteriorly and superiorly due to fluid in the intraarticular space A posterior fat pad is always abnormal. It