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Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: EDU-011 (T)
The Stop Sign Method: An Alternative Radiographic Position for the True Lateral Elbow Projection.
Purpose or Case Report: The purpose of this retrospective observational study is to provide an alternative if not optimal lateral elbow projection method to be considered for use in traumatic injuries with suspected distal humeral fractures and/or observable deformity at the distal humerus.
Abstract: The true lateral radiograph of the distal humerus commonly contributes to the decision of Gartland classification of supracondylar fractures and other distal humerus fractures. This is important when deciding which elbow fractures require invasive surgery and anesthesia as opposed to a reduction with conscious sedation. While the Elbow Lateral Projection (Lateromedial) in current practice typically results in a perfect lateral radiograph for adult patients, this method does not result in a true lateral of the distal humerus in pediatric patients. The condyles are rarely superimposed and the signature “hour glass” sign is imperfect. The Stop Sign Method is a medial to lateral projection that routinely results in a true lateral of diagnostic quality and meeting textbook qualification. Not only is positioning in the Stop Sign method more comfortable for trauma clients, it produces a more consistent radiograph when utilized on follow-up orthopaedic visits and enables clinicians to better track reduction retention and healing.
Methods & Materials: Review of past radiographs of distal humeral fractures performed by a team of blind, radiologic technologists imaging pediatric clients in a busy Emergency Department setting, utilizing current procedures and a specific protocol of radiographic positioning. Use of a mediolateral projection was used in patients that were unable to comply with the lateromedial projection due to immobility attributable to injury or other underlying condition.
Results: Noted success in achieving a true lateral elbow radiograph by utilizing the stop sign method instead of the conventional methods as outlined in the current radiologic technologist's curriculum.
Conclusions: Utilization of the Stop Sign method for imaging of pediatric patients results in a true lateral as evidenced by fewer films needed to achieve a true lateral of the distal humerus both post trauma and on serial visits and cast changes.
Abstract: The true lateral radiograph of the distal humerus commonly contributes to the decision of Gartland classification of supracondylar fractures and other distal humerus fractures. This is important when deciding which elbow fractures require invasive surgery and anesthesia as opposed to a reduction with conscious sedation. While the Elbow Lateral Projection (Lateromedial) in current practice typically results in a perfect lateral radiograph for adult patients, this method does not result in a true lateral of the distal humerus in pediatric patients. The condyles are rarely superimposed and the signature “hour glass” sign is imperfect. The Stop Sign Method is a medial to lateral projection that routinely results in a true lateral of diagnostic quality and meeting textbook qualification. Not only is positioning in the Stop Sign method more comfortable for trauma clients, it produces a more consistent radiograph when utilized on follow-up orthopaedic visits and enables clinicians to better track reduction retention and healing.
Methods & Materials: Review of past radiographs of distal humeral fractures performed by a team of blind, radiologic technologists imaging pediatric clients in a busy Emergency Department setting, utilizing current procedures and a specific protocol of radiographic positioning. Use of a mediolateral projection was used in patients that were unable to comply with the lateromedial projection due to immobility attributable to injury or other underlying condition.
Results: Noted success in achieving a true lateral elbow radiograph by utilizing the stop sign method instead of the conventional methods as outlined in the current radiologic technologist's curriculum.
Conclusions: Utilization of the Stop Sign method for imaging of pediatric patients results in a true lateral as evidenced by fewer films needed to achieve a true lateral of the distal humerus both post trauma and on serial visits and cast changes.
More abstracts on this topic:
Gartland Classification Comparison of Supracondylar Fractures Between Emergency Room Physicians, Radiologists, and Orthopedic Surgeons: An Effective Communication Tool for Operative and Non-operative Triage?
Schultz Rebecca, Henkel Erin, Smith Brian, Kan J., Amaral Jason, Bridges Callie, Gladstein Aharon, Wall Jon, Bih Eric, Kraus Steven, Cruz Andrea, Allen Joseph
Navigating the Upper Extremity: A Roadmap for the Normal Radiographic Appearance of the Developing Shoulder and ElbowKosaraju Sriya, Errampalli Eric, Illimoottil Mathew, Priya Lakshmi, Orscheln Emily
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