复位前X片骨折移位方向
应特别注意肱桡线:在任何x线片上,沿桡骨骨干长轴画的线应与小头相交。任何偏差都暗示着桡骨头半脱位或脱位
复位后X片上的关节连贯性
常规非应力复位后肘关节侧位片上出现下降征(尺肱骨距离≥4 mm):复位后立即的x线片上可能出现下降征,在随访x线片上通常消失。随访x线片上持续下降的迹象可能是肘关节不稳的迹象
关节渗出物
可见前脂肪垫升高和/或可见后脂肪垫:在创伤后,隐匿性骨折很可能伴有肘关节积液和影像学上无法检测到的骨折。
当肘关节骨折或脱位合并关节囊破裂时,可能不存在关节积液
骨折的特征和分类
桡骨头骨折可能不明显,仅在侧斜位或桡骨头视图上可见
关节内骨碎片的数量和位置
参考文献
[1]Kani, K.K., Chew, F.S. Terrible triad injuries of the elbow. Emerg Radiol 26, 341–347 (2019).
[2]Xiao K, Zhang J, Li T, Dong YL, Weng XS. Anatomy, definition, and treatment of the 'terrible triad of the elbow' and contemplation of the rationality of this designation. Orthop Surg. 2015 Feb;7(1):13-8.
[3]Al-Ani, Z., Tham, JL., Ooi, M.W.X. et al. The radiological findings in complex elbow fracture-dislocation injuries. Skeletal Radiol (2021).
[4]关节周围骨折/姜保国等主编.—北京:人民卫生出版社,2012
[5]Rhyou IH, Lee JH, Cho CH, Park SG, Lee JH, Kim KC. Patterns of injury mechanism observed in terrible triad. J Shoulder Elbow Surg. 2021;30(9):e583-e593.
[6]Pizzoli A, Bondi M, Schirru L, Bortolazzi R. The use of articulated external fixation for complex elbow trauma treatment. Musculoskelet Surg. 2021 Apr;105(1):75-87.
[7]Zha YJ, Xiao D, Hua KH, Sun WT, Gong MQ, Li T, Chen C, Jiang XY. Lateral minimal approach to the terrible triad of the elbow: a treatment protocol in Beijing Jishuitan Hospital. Ann Transl Med. 2021 Aug;9(15):1232.
[8]He X, Fen Q, Yang J, Lei Y, Heng L, Zhang K. Risk Factors of Elbow Stiffness After Open Reduction and Internal Fixation of the Terrible Triad of the Elbow Joint. Orthop Surg. 2021 Apr;13(2):530-536.
[9]书名:骨科疾病的分类与分型标准(第2版)作者:胡永成,马信龙,马英出版社:人民卫生出版社出版时间:2014-02
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