Departments of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
Radiographics. 2013 May;33(3):869-88. doi: 10.1148/rg.333125176.
Traumatic elbow injuries are commonly encountered in the emergency department setting, but their complexity and clinical significance often go unrecognized at the initial evaluation. Initial imaging in patients with elbow trauma should not only help identify major injuries that require immediate intervention but also allow detection of other, often more subtle injuries that may lead to instability or poor functional outcomes if appropriate treatment is delayed. Awareness and detection of these injuries may be improved by a better-developed and more intuitive understanding of the mechanisms that underlie the most common injury patterns. Ideally, such understanding should prompt appropriate early use of advanced imaging techniques. Traumatic elbow injuries should be described in the radiology report within the context of their clinical significance and their implications for management, information that is often best captured by the injury grading and classification systems used by the orthopedic surgery community. This article reviews the relevant anatomy and functional stability of the elbow and discusses common traumatic elbow injury patterns, including elbow dislocations as well as fractures of the distal humerus, radial head and neck, coronoid process, and olecranon. Less commonly encountered injury constellations that are clinically significant are also described. Injury patterns are explained in the context of the responsible force mechanism by using three-dimensional modeling and animation, with emphasis on the functional impact of associated secondary bone and soft-tissue injuries. The utility of cross-sectional imaging modalities such as computed tomography and magnetic resonance imaging in the acute care setting is discussed, and specific imaging guidelines are provided. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.333125176/-/DC1.
创伤性肘部损伤在急诊科中很常见，但在初始评估时，这些损伤的复杂性和临床意义往往未被认识到。肘部创伤患者的初始影像学检查不仅有助于确定需要立即干预的主要损伤，还可以发现其他可能导致不稳定或功能不良结果的更细微损伤，如果延迟适当的治疗。通过更好地理解最常见损伤模式的潜在机制，可以提高对这些损伤的认识和检测。理想情况下，这种理解应促使尽早使用适当的高级影像学技术。在放射学报告中，应根据其临床意义及其对管理的影响来描述创伤性肘部损伤，这些信息通常通过骨科手术界使用的损伤分级和分类系统来最佳捕捉。本文回顾了肘部的相关解剖结构和功能稳定性，并讨论了常见的创伤性肘部损伤模式，包括肘部脱位以及肱骨远端、桡骨头和颈、冠状突和尺骨鹰嘴骨折。还描述了一些不太常见但具有临床意义的损伤组合。通过使用三维建模和动画，根据负责的力机制解释损伤模式，并强调相关继发性骨和软组织损伤的功能影响。讨论了在急性护理环境中使用 CT 和 MRI 等横断面成像方式的效用，并提供了具体的成像指南。补充材料可在 http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.333125176/-/DC1. 上获得。
