Journal Club: RC radiograph helps identify operative elbow fractures

Having a radiocapitellar (RC) view of medial epicondyle fractures, in addition to anteroposterior (AP) and lateral radiographs, significantly increases sensitivity in detecting the 5-mm displacement threshold for operative treatment of pediatric medial epicondyle fractures. This was the finding of a retrospective analysis of the records of 45 children who received AP and RC radiographs followed by operations for a medial epicondyle fracture.

The average age of the patients was 11 years; 29 were girls, 16 were boys, and all had at least 1 AP or RC radiograph that showed a displacement of greater than 5 mm. The RC view, which offers an additional perspective for interpreting elbow injuries by separating the humeroradial and humeroulnar joints for greater visualization, had significantly higher sensitivity for identifying fractures greater than the operative threshold of 5 mm than did the AP view. On average, the RC view measured 2.5 mm more displacement.

Specifically, the AP radiograph measured fractures with displacement of greater than 5 mm in 68.9% of patients, compared with the RC radiograph, which measured fractures with displacement of greater than 5 mm in 93.3% of patients. Both radiographs identified fractures with a depth of greater than 5 mm in 62.2% of patients. However, for 31.1% of patients, the RC view measured a fracture of greater than 5 mm when the AP view did not. Conversely, the AP view measured a fracture of greater than 5 mm for only 6.7% of patients when the RC view did not. These differences were statistically significant in patients aged 6 to 8 years and in those aged 12 to 13 years.

The study authors noted that though the RC view may enable improved assessment of medial epicondyle fracture displacement, providing additional information for making operative decisions by optimizing the view of the joint and allowing for better examination of the full extent of the injury, the usefulness of the RC view depends on consistent training and application of a standardized method of measurement.

THOUGHTS FROM DR FARBER

If you have a patient with an elbow fracture, make sure you or your orthopedic colleagues remember to order this view. Missing a fracture that requires surgery can have significant long-term effects, particularly in a growing child.

Reference

Callanan TC, Milner JD, Lou MY, et al. The utility of the radiocapitellar view in pediatric medial epicondyle fracture evaluation. J Pediatr Orthop. 2025;45(5):258-263. doi:10.1097/BPO.0000000000002902