Computed Tomography Assisted-Detection of Occult Elbow Fractures in adult Patients with Positive Elbow Extension Test

Abstract
Background: Elbow fractures are a common injury seen among Emergency Department trauma patients accounting for 2-3% of Emergency Department attendances. Eight to ten percent of fractures in adults occur in the elbow and forearm an effective clinical decision rule to exclude fracture in acute elbow injury would prevent unnecessary radiography, and could reduce missed injuries. Previous small studies indicate that the ability to fully extend the elbow might rule out clinically significant bony injury.
Aim of the Work: The aim of this work was to detect occult adult elbow fractures using computed tomography in adult patients who presented with positive elbow extension test and had no evident fracture on X-ray study.
This was to test the effectiveness of positive elbow ex-tension test as an indication to perform further radiographic evaluation of the injured elbow.
Material and Methods: A prospective study was conducted in the Emergency Department (ED) of Tanta University Hospitals. All patients underwent the standard procedures of the protocol.
Our study was carried out upon forty (40) patient of both sex in a duration of one (1) year from October 2016 to October 2017. They were selected from those who presented to Tanta University, Emergency Department.
Results: In this study, age of about 57.5% of patients were ranged 19-39 years. While only about 5% of patients were equal or more than 60 years old.
In patients with CT show elbow fracture, mean age was 38.27, while in patients had no elbow fracture mean age was 36.89. There was no statistically significant difference between patients.
The most commonly occult elbow fracture detected by CT in patient with positive elbow extension test was radial head fracture (22.5% of all studied patients).
About 20% of patients was diagnosed as coronoid process fracture, 5% of patients was diagnosed as olecranon process fracture and 5% of patients was diagnosed as lateral epicondyle fracture. Only about 2.5% of patients was diagnosed as medial epicondyle fracture.
Conclusions: In patients with positive elbow extension test adding computed tomography to plain radiograph (that showed no evident fracture) was found to be superior to plain X-ray alone.