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  • Views: AP (full-extension), radial head & capitulum, lateral (90 degree flexion).
  • Terrible triad of elbow injuries = coronoid process fractur + radial neck fracture + displacement of the radial head.

A. Alignment: lateral view

  • Anterior humeral line: at least 1/3 of the capitulum should be anterior to the anterior humeral line. If this is dirsupted = possibility of lateral condyle fracture.
  • Radio-capitellar line: line through the neck of the radius should intersect through the center of the capitulum.

B. Bones

  • Elbow ossification centers: CRITOE. Capitulum (birth); Radial head (2 years); Internal epicondyle (4 years); Trochlea (6 years); Olecranon (8 years); External epicondyle (10 years).
  • Radial head or neck fractures are morthe common in adults.

S. Soft tissue

  • SAIL sign: elevation of the anterior and posterior fat pads. Elevated posterior fat pad is always abnormal. This indicates haemarthrosis or a fracture (maybe occult).
  • If you see a joint effusion in an adult, there MUST be a fracture! If an occult fracture is suspected: think of radial head/neck fractures in adults and supracondylar fractures in children.


1. Goodman, L. and Felson, B. (2015). Felson's principles of chest roentgenology. 3rd ed. Philadelphia, PA: Elsevier, Saunders.
2. Dähnert W. Radiology Review Manual. LWW. (2011) ISBN:1609139437. Read it at Google Books - Find it at Amazon
3. Elizabeth Puddy, Catherine Hill; Interpretation of the chest radiograph, Continuing Education in Anaesthesia Critical Care & Pain, Volume 7, Issue 3, 1 June 2007, Pages 71–75, https://doi.org/10.1093/bjaceaccp/mkm014

Ⓒ A. Manickam 2018

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