eMedicine Specialties > Radiology > Musculoskeletal

Elbow, Fractures and Dislocations - Adult

Ricardo Riego de Dios, MD, Staff Physician, Department of Diagnostic Radiology, Naval Hospital Jacksonville, Naval Air Station
Burl Norris, MD, Consulting Staff, Department of Radiology, Naval Medical Center Portsmouth

Updated: May 1, 2009

Introduction

Background

Although the elbow is one of the most stable joints in the body, elbow dislocations and fractures are common. In adults, elbow dislocations are second only to shoulder dislocations in frequency; the elbow is the most frequently dislocated joint in pediatric patients.¹  

Elbow dislocations are classified as either simple or complex. Simple dislocations are classified by the direction of radial and/or ulnar displacement in relation to the distal part of the humerus. Complex elbow dislocations involve related fractures and/or neurovascular injuries.

Elbow fractures are classified as distal humeral, radial, and ulnar. The frequency of the different fracture types varies with the mechanism of injury and the age of the patient. In adults, radial head fracture is the most common type.

Elbow, fractures and dislocations. Anteroposterior (AP) radiograph of the forearm demonstrates a posterior dislocation of the elbow. Note the discontinuity of the radiocapitellar line. Also note the overlap of the articular surfaces of the trochlea and ulna.

Elbow, fractures and dislocations. Lateral view shows an elbow with a subtle radial head fracture. The presence of the sail sign and the posterior fat pad suggest an associated fracture.

Elbow, fractures and dislocations. Lateral radiograph of the elbow demonstrates a superiorly displaced fracture of the capitellum.

Frequency

United States

Hildebrand et al reported that the annual incidence of elbow dislocations is 6-8 cases per 100,000 population² ; these dislocations represent 11-28% of all injuries to the elbow. Posterior dislocations of the elbow are the predominant type and account for 80-90% of all elbow dislocations.

About 30% of elbow fractures in adults occur in the radial head. Olecranon process fractures account for 10-20% of all elbow injuries in adults.^3,4 Coronoid process fractures occur in 10-15% of dislocations of the elbow.

Rare fractures in adults include those in the supracondylar humerus, capitellum, and trochlea. Fewer than 2% of elbow fractures affect the distal humerus. Capitellar fractures account for 0.5-1% of elbow injuries, and trochlear fractures are less common.^5,6

International

Although international data are not readily available, the incidence and distribution likely correspond with those of the United States.

Mortality/Morbidity

Complications of elbow dislocations and elbow fractures are possible (see Clinical Details, Complications).

Age

The radial head fracture is the most common elbow fracture in adults (ie, individuals in whom the physes at the elbow have closed). See also Frequency.

• Supracondylar fractures occur mostly in children and adolescents with immature skeletons.
• Transcondylar fractures are more common in elderly persons with osteoporosis.
• Intercondylar fractures occur in persons 40-60 years old.

Presentation

Anatomy

The elbow is a hinge joint that comprises the following articulations:

• The humeroradial articulation, which is formed by the radial head and the capitellum of the humerus
• The humeroulnar articulation, which is formed by the ulnar notch and the trochlea of the humerus
• The superior radioulnar articulation, which is formed by the proximal parts of the radius and ulna.

The clinical presentations and mechanisms of injury in elbow fractures and dislocations vary. Almost all patients present in the acute care setting with history of recent trauma. Some patients may have a delayed presentation or even one that is remote from elbow injury; these patients must be thoroughly examined for associated morbidity.

Complications of elbow dislocations include the following:

• Posttraumatic periarticular calcification, which occurs in 3-5% of elbow injuries
• Myositis ossificans or calcific tendinitis³
• Neurovascular injuries (8-21% of cases) — ulnar nerve injuries are most common, followed by brachial artery injuries (5-13%)
• Osteochondral defects, intra-articular loose bodies, and avascular necrosis of the capitellum 
• Instability

Complications of elbow fractures are possible. With supracondylar fractures, Volkmann ischemic contracture and malunion may occur; as with supracondylar fractures in general, these complications most commonly occur in children. With transcondylar fractures, loss of motion can result from callus formation in the olecranon or coronoid fossae. With intercondylar fractures, a loss of joint function may result. With condylar fractures, possible complications include nonunion, arthritis, cubitus varus or valgus deformity, and lateral transposition of the forearm. Coronoid process fractures, if left untreated, may lead to instability of the joint. With radial head fractures, a loss ofelbow extension and forearm rotation may result. With olecranon fractures, nonunion and loss of motion may result.

In the capitellum, traumatic arthritis, avascular necrosis of the fracture fragment, and limited range of motion may result.

If a radial head dislocation (eg, in a Monteggia fracture-dislocation) is overlooked, an irreducible radial head dislocation can cause pain and limit pronation and supination.

Preferred Examination

It has been suggested that radiologic studies may be unnecessary for the evaluation of elbow trauma if the active range of motion of the elbow remains normal^8,9 ; even the ability to fully extend the elbow while in a supine position may be sufficient to obviate radiography.^10,11 In such cases, patients may be advised to return in 7-10 days if their symptoms do not resolve.¹⁰

The preferred study for the evaluation of elbow trauma is conventional radiography.¹² Radiographic examination requires the acquisition of 2 views: anteroposterior (AP) view in full extension and lateral view in 90° flexion. In children, oblique projections may be useful if the frontal and lateral projections do not show a fracture and fat pad signs are evident; internal oblique views are also valuable for providing further evaluation of lateral condylar fractures of the humerus in children.¹³

On radiographs, an anterior humeral line (see Image below) is parallel to the anterior cortex of the humerus. This line should intersect the distal, middle third of the capitellum. Displacement of this line suggests the presence of subtle supracondylar fractures.

Elbow, fractures and dislocations. Lateral radiograph of the elbow shows the anterior humeral line drawn along the anterior humeral cortex. This line passes through the middle third of the capitellum. The radiocapitellar line bisects the proximal radial shaft and extends through the capitellum in every view.

Elbow, fractures and dislocations. Lateral view shows an elbow with a subtle radial head fracture. The presence of the sail sign and the posterior fat pad suggest an associated fracture.

When a fracture of the radial head, coronoid process, or capitellum is suspected, a radial head–capitellar view should be obtained. This view is a variant of the lateral projection that magnifies the structures and eliminates the overlap of joint surfaces. The view is obtained by positioning the patient with his or her forearm resting on the ulnar side, with the elbow flexed 90° and thumb pointing upward. The beam is pointed at the radial head with a 45° angle to the forearm.

Limitations of Techniques

Differential Diagnoses

Elbow Trauma, Pediatric

Other Problems to Be Considered

Fractures, Humerus
Fractures, Forearm
Trauma, Neurovascular Injuries
Neurovascular complications
Instability of the elbow secondary to ligamentous or tendinous injury
Heterotropic calcification and ossification of locally injured muscles, tendons, and ligaments
Intra-articular loose bodies and osteochondral defects
Avascular necrosis of the capitellum (Severe complex fracture-dislocation with involvement of the capitellum may result in compromise of its rather fragile blood supply.)

Radiography

Elbow, fractures and dislocations. Anteroposterior (AP) radiograph of the forearm demonstrates a posterior dislocation of the elbow. Note the discontinuity of the radiocapitellar line. Also note the overlap of the articular surfaces of the trochlea and ulna.

Elbow, fractures and dislocations. Lateral view of the forearm demonstrates a posterior dislocation of the radius and ulna in relation to the distal humerus.

Elbow, fractures and dislocations. Lateral view of the elbow demonstrates a posterior dislocation of the elbow. The patient also had a nondisplaced radial head fracture.

Elbow, fractures and dislocations. Lateral view shows an elbow with a subtle radial head fracture. The presence of the sail sign and the posterior fat pad suggest an associated fracture.

Elbow, fractures and dislocations. Radial head–capitellar view demonstrates a nondisplaced fracture of the radial head. This fracture was not seen on the lateral radiograph.

Elbow, fractures and dislocations. Lateral radiograph of the elbow demonstrates a superiorly displaced fracture of the capitellum.

Elbow, fractures and dislocations. Lateral view of the elbow demonstrates a displaced olecranon fracture.

Elbow, fractures and dislocations. Lateral view of the elbow demonstrates a displaced radial neck fracture.

Elbow, fractures and dislocations. Anteroposterior (AP) radiograph of the elbow demonstrates a T-type condylar fracture.

Elbow, fractures and dislocations. Lateral radiograph of the elbow demonstrates a comminuted supracondylar fracture.

Findings

Elbow dislocations

Adult elbow dislocations are classified by the direction of displacement and the presence or absence of associated fractures. Simple elbow dislocations are solely soft tissue injuries. The direction can be anterior, posterior, lateral, or divergent. The most common dislocation involves posterior displacement of both the radius and ulna in relation to the distal humerus. Less common dislocations are the following: medial and lateral dislocations, anterior dislocations, translocation of the elbow, divergent dislocations, and isolated dislocations of either the radius or ulna.

Complex elbow dislocations have associated fractures that compromise joint stability. The most common associated fractures are those of the radial head and coronoid process. The combination of posterior elbow dislocation, radial head fracture, and coronoid fracture has been termed the "terrible triad".¹⁴  Associated injuries involving structures other than the elbow (eg, the shoulder, distal radius or ulna, and carpal bones) occur in 10-15% of cases.²

The Essex-Lopresti fracture-dislocation consists of a comminuted radial head fracture and a distal radioulnar joint dislocation, along with tearing of the interosseus membrane; it typically results from high-energy trauma.¹⁵

Monteggia fracture-dislocations involve ulnar fracture accompanied by dislocation of the radial head. Table 1 summarizes the Bado classification system for Monteggia fracture-dislocations.

Table 1. Bado Classification of Monteggia Fracture-Dislocation

Mechanism of injury

Most dislocations occur as a result of a fall on an outstretched hand (FOOSH). Elbow dislocations and fractures can also occur with a high-energy direct impact.

Preferred examination

AP and lateral radiographs of the elbow are most effective in demonstrating elbow dislocations. Postreduction films should be examined for associated fractures. Radiographic findings include displacement of the radius and/or ulna relative to the distal humerus, with or without evident fracture lines.

Elbow fractures

Elbow fractures are classified into 3 categories: (1) distal humerus fractures, (2) proximal radius fractures, and (3) proximal ulna fractures.

Table 2. Muller Classification of Distal Humerus Fractures

Supracondylar fractures

Supracondylar fractures are the most common elbow fractures in pediatric patients. Typically, patients are 3-10 years old. In the immature skeleton, the collateral ligaments and joint capsule are stronger than the bone. The opposite is true in the mature skeleton. Therefore, supracondylar fractures seldom occur in adults. Two types of supracondylar fractures are possible: flexion fractures and extension fractures. These types are subdivided into categories on the basis of displacement and cortical integrity. Also, because the immature elbow has developing physes, Salter-Harris fractures may occur.

Salter-Harris type I supracondylar fractures occur most frequently in infants and toddlers. The Salter-Harris type I fracture affects only the physis, with separation of the epiphysis from the metaphysis. These fractures are minimally displaced or nondisplaced. Radiographic findings are subtle and include the presence of a posterior fat pad due to hemarthrosis or perhaps a widening of the physis.

Elbow dislocations may be mistaken for Salter-Harris type I supracondylar fractures. Correct distinction is important because an improperly treated dislocation can lead to chronic joint dysfunction. In a physeal separation, the relationship of the capitellum to the humerus is disrupted while that of the capitellum to the radial head remains normal. In an elbow dislocation, the alignment between the radial head and capitellar epiphysis is lost. Further cross-sectional imaging may be necessary to delineate the injury.

True supracondylar fractures may result from trauma during extension (eg, FOOSH with the elbow in full extension) or flexion (eg, direct impact to a flexed elbow). The preferred studies are AP and lateral radiographs, with CT as needed to assess the position of comminuted fragments. Radiographic findings include a fracture line proximal to the humeral epicondyles, joint effusion (eg, fat pad sign), and disruption of the anterior humeral line. Treatment for a nondisplaced fracture is immobilization. Patients with a displaced fracture should be referred to an orthopedist.

Transcondylar fractures

Transcondylar fractures are classified into flexion and extension types on the basis of the position of the elbow during impact. The mechanism of injury is a FOOSH. The preferred studies are AP and lateral radiographs and CT to assess the position of comminuted fragments. On the images, the fracture line extends through the condyles proximal to the articular surface. Treatment is difficult, because the amount of bone available for proper union is limited; the patient should be referred to an orthopedist.

Intercondylar fractures

These are T- or Y-shaped fractures with varying amounts of displacement between the condyles and from the humerus. The mechanism of injury is indirect trauma: the olecranon is forced against the articular surface of the humerus and splits the end of the humerus. The preferred studies are AP and lateral radiographs; CT can be used to guide surgical intervention. On the images, a fracture is present between condyles, and the condyles are separated from the humeral shaft. Treatment is open reduction and internal fixation (ORIF).

Condylar fractures

These fractures are divided into medial and lateral condylar fractures. Lateral condyle fractures are more common. The mechanism of injury with lateral fractures is direct impact to the lateral elbow during flexion; medial fractures involve an impact to the olecranon process with a flexed elbow. The preferred study is plain radiography; CT is used as needed. Radiographic findings include a widened intercondylar distance with lateral fractures; commonly, a fragment is posteriorly and inferiorly displaced. With medial fractures, the fragment is commonly anteriorly and inferiorly displaced. Fractures typically involve the joint surface and nonarticular parts of the distal humerus. Treatment for nondisplaced fractures is immobilization. Fractures that are displaced by more than 3 mm require surgical fixation.

Capitellar fractures

A capitellar fracture is one that involves the articular surface of the distal humerus. Most commonly, these occur with posterior elbow dislocations. The mechanism of injury is a FOOSH in which the radial head shears the capitellum. The preferred study is lateral elbow radiography. On radiographs, the fragment is medial relative to the normal position, with visible joint effusion. The treatment of nondisplaced fractures is immobilization.

Displaced fractures require surgical treatment.¹⁶ In a prospective, randomized study by McKee et al of elderly patients with displaced, intra-articular distal humeral fractures, total elbow arthroplasty (TEA) was found in many instances to provide superior results compared with open reduction and internal fixation (ORIF). Of 21 patients randomized to ORIF, 5 needed to be converted to TEA because of unstable fixation. Operative time was 32 minutes less for the TEA group. Mayo Elbow Performance Scores (MEPSs) were significantly better for TEA patients at 3 months, 6 months, 12 months, and 2 years. TEA patients also had better DASH (Disabilities of the Arm, Shoulder, and Hand) scores at 6 weeks and 6 months, but not at 1 year or at 2 years follow-up. TEA patients had a mean flexion-extension arc of 107º; ORIF patients, 95º. TEA may therefore be preferred for elderly patients with complex distal humeral fractures.¹⁷

Olecranon fractures

The many classifications of olecranon fractures are based on the displacement, the number of fracture lines, and the subdivisions of the olecranon process. No classification system is universally accepted. The mechanism of injury is a direct impact or FOOSH. The preferred study is lateral radiography. Radiographs demonstrate the fracture and amount of displacement. Displaced fractures are defined by a separation of more than 2 mm or increased separation with elbow flexion. On radiographs, a fracture line is evident through the olecranon process. The treatment for nondisplaced fractures is immobilization. Displaced fractures require ORIF.

Mason fractures

Mason fractures are radial head fractures; they are classified into 4 types, as shown in Table 3.

Table 3. Mason Classification of Fractures

The mechanism of injury is a FOOSH that forces the radial head against the capitellum. The preferred study is lateral radiography of the anterior aspect of the radial head and the radial head and capitellum to evaluate the posterior aspect of the radial head or occult fractures. Radiographic findings vary from comminution to marginal fractures involving impaction, depression, or angulation. Nondisplaced fractures may result in only a posterior fat pad or the anterior sail sign.

The treatment of type I and type II fractures is joint aspiration followed by immobilization. Radial head osteoplasty may be required in fractures that fail to heal. Type III fractures and type II fractures with a mechanical block are treated with radial head revision. Type IV fractures are first treated for dislocation and then for the fracture, according to its Mason classification. Other indications for ORIF include cleavage fractures of the articular surface involving one third of the head or 3- to 4-mm displacement involving half of the radial head.

Degree of Confidence

As discussed in Limitations of Techniques, plain radiographs can be limited by patient positioning, patient compliance, and technique. The sail sign and posterior fat pad should always raise suspicion if fractures are not evident; in patients with these findings, the authors recommend conservative treatment and repeat plain radiography in 7-10 days. Cross-sectional imaging should be reserved for surgical planning in the acute setting and for later evaluation of associated soft tissue involvement.

False Positives/Negatives

False-positive findings may be caused by the misinterpretation of a normal anterior fat pad or, more likely, by the presence of old avulsive injuries of the condyles. False-negative readings depend on the skill of the interpreting physician, the quality of the studies, and the conspicuity of the fractures.

Computed Tomography

Elbow, fractures and dislocations. Axial CT scan of the elbow demonstrates a displaced capitellar fracture. This image was obtained for surgical planning.

Findings

CT is selectively used in acute or subacute settings to evaluate the displacement of fractures or to delineate osteochondral fragments in the joint.

Degree of Confidence

If thin-section multidetector-row CT is complemented with multiplanar reconstructions, the degree of confidence in the findings is high.

Magnetic Resonance Imaging

Elbow, fractures and dislocations. Axial T1-weighted MRI of the elbow demonstrates an ossific fragment from a prior injury that caused ulnar nerve impingement. Associated abnormal hyperintensity is depicted in the ulnar nerve. The patient presented with radicular pain in the ulnar distribution after a prior fracture-dislocation of the elbow.

Findings

MRI has a limited role in the acute setting. In the subacute setting, MRI is invaluable in the assessment of the collateral ligaments; common extensor and flexor tendon originations; articular cartilage; and, to a lesser extent, occult fractures. MRI and MRI arthrography are superior to CT arthrography for detecting occult bone injuries in the elbow.¹⁸   MRI can detect the osteochondral and ligamentous injuries that often accompany acute radial head fractures (Mason type II and III).

MRI may be used to assess the status of the interosseus membrane when a longitudinal radioulnar dissociation is suspected. Also, MRI can be used to visualize major neurovascular structures that cross the joint.

As peripheral magnetic resonance angiography (MRA) is more widely used, it may come to have a role in the assessment of acute vascular injury in the elbow.

Angiography

Findings

Arteriography is rarely indicated in the absence of definite signs of arterial injury (eg, pulsatile hemorrhage, absent distal pulses, overt distal ischemia, audible bruit, and a palpable thrill). Arteriography is primarily used to assess the brachial artery at the elbow. Transection, thrombosis, dissection, and intimal flaps may be found.

Intervention

See the discussions for the various fractures in Radiograph .

Medicolegal Pitfalls

• The following pearls should help to limit the number of missed cases:
  • On plain radiographs, look for the presence of the fat pad sign. A posterior fat pad sign is always an abnormal finding, and underlying bony or ligamentous injury should be investigated.
  • The radial head–capitellar view is a useful adjunct in assessing fractures in the posterior half of the radial head, coronoid process, and capitellum.
  • Look for associated fractures on postreduction radiographs of elbow dislocations. Missed coronoid process fractures may lead to recurrent subluxation or dislocation.
  • In each case of an ulnar fracture, look for associated radial head dislocations (ie, Monteggia fracture-dislocations). Conversely, in cases of radial dislocations, look for an associated ulnar fracture.
  • A painful posttraumatic elbow with negative plain radiographic findings warrants conservative treatment; follow-up radiographs, including repeat radial head–capitellar views, should be obtained in 7-10 days.

Multimedia

Media file 1: Elbow, fractures and dislocations. Anteroposterior (AP) radiograph of the elbow demonstrates the normal anatomy.

Media file 2: Elbow, fractures and dislocations. Lateral radiograph of the elbow demonstrates the normal anatomy.

Media file 3: Elbow, fractures and dislocations. Oblique view of the elbow demonstrates the normal anatomy.

Media file 4: Elbow, fractures and dislocations. Radial head–capitellar view shows the normal anatomy. This view is used to assess occult fractures of the posterior half of the radial head, coronoid process, and capitellum.

Media file 5: Elbow, fractures and dislocations. Lateral radiograph of the elbow shows the anterior humeral line drawn along the anterior humeral cortex. This line passes through the middle third of the capitellum. The radiocapitellar line bisects the proximal radial shaft and extends through the capitellum in every view.

Media file 6: Elbow, fractures and dislocations. Anteroposterior (AP) radiograph of the forearm demonstrates a posterior dislocation of the elbow. Note the discontinuity of the radiocapitellar line. Also note the overlap of the articular surfaces of the trochlea and ulna.

Media file 7: Elbow, fractures and dislocations. Lateral view of the forearm demonstrates a posterior dislocation of the radius and ulna in relation to the distal humerus.

Media file 8: Elbow, fractures and dislocations. Anteroposterior (AP) view of the elbow demonstrates a posterior-medial fracture-dislocation of the elbow.

Media file 9: Elbow, fractures and dislocations. Lateral view of the elbow demonstrates a posterior dislocation of the elbow. The patient also had a nondisplaced radial head fracture.

Media file 10: Elbow, fractures and dislocations. Lateral view shows an elbow with a subtle radial head fracture. The presence of the sail sign and the posterior fat pad suggest an associated fracture.

Media file 11: Elbow, fractures and dislocations. Lateral view of the elbow demonstrates the posterior fat pad, the sail sign, and the comminuted radial head fracture.

Media file 12: Elbow, fractures and dislocations. Radial head–capitellar view demonstrates a nondisplaced fracture of the radial head. This fracture was not seen on the lateral radiograph.

Media file 13: Elbow, fractures and dislocations. Lateral radiograph of the elbow demonstrates a superiorly displaced fracture of the capitellum.

Media file 14: Elbow, fractures and dislocations. Lateral view of the elbow demonstrates a displaced olecranon fracture.

Media file 15: Elbow, fractures and dislocations. Lateral view of the elbow demonstrates a displaced radial neck fracture.

Media file 16: Elbow, fractures and dislocations. Anteroposterior (AP) radiograph of the elbow demonstrates a T-type condylar fracture.

Media file 17: Elbow, fractures and dislocations. Lateral radiograph of the elbow demonstrates a comminuted supracondylar fracture.

Media file 18: Elbow, fractures and dislocations. Axial CT scan of the elbow demonstrates a displaced capitellar fracture. This image was obtained for surgical planning.

Media file 19: Elbow, fractures and dislocations. Axial T1-weighted MRI of the elbow demonstrates an ossific fragment from a prior injury that caused ulnar nerve impingement. Associated abnormal hyperintensity is depicted in the ulnar nerve. The patient presented with radicular pain in the ulnar distribution after a prior fracture-dislocation of the elbow.

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Keywords

humerus fractures, distal humeral fractures, radial fractures, ulnar fractures, forearm trauma, neurovascular injuries, Monteggia fracture-dislocation, simple elbow dislocation, complex elbow dislocation, fall on an outstretched hand, FOOSH

Contributor Information and Disclosures

Author

Ricardo Riego de Dios, MD, Staff Physician, Department of Diagnostic Radiology, Naval Hospital Jacksonville, Naval Air Station
Ricardo Riego de Dios, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Phi Beta Kappa, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Burl Norris, MD, Consulting Staff, Department of Radiology, Naval Medical Center Portsmouth
Disclosure: Nothing to disclose.

Medical Editor

Michael A Bruno, MD, Associate Professor, Departments of Radiology and Medicine, Pennsylvania State University College of Medicine; Director, Radiology Quality Management Services, Milton S Hershey Medical Center, Pennsylvania State University College of Medicine
Michael A Bruno, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, Society of Nuclear Medicine, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Theodore E Keats, MD, Professor, Departments of Radiology and Orthopedics, University of Virginia School of Medicine
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

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Clinical guidelines

Evidence-based care guideline for loss of elbow motion following surgery or trauma in children aged 4 to 18. Cincinnati Children's Hospital Medical Center - Hospital/Medical Center.  2007 Dec.  9 pages.  NGC:006291

Elbow (acute & chronic). Work Loss Data Institute - Public For Profit Organization.  2003 (revised 2008 May 28).  161 pages.  NGC:006555

ACR Appropriateness Criteria® chronic elbow pain. American College of Radiology - Medical Specialty Society.  1998 (revised 2005).  5 pages. [NGC Update Pending] NGC:004605

Clinical trials

Progressive Splinting Status Post Elbow Fractures and Dislocations

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