Utility of Computed Tomography in Elbow Trauma Patients with Normal X-Ray Study and Positive Elbow Extension Test

Elbow fractures are a common injury seen among emergency department trauma patients. Despite its high frequency, there is no standardized method of diagnosis using conventional x-ray imaging for trauma patients presenting with elbow pain and restricted elbow movement.

We aimed to assess trauma patients, using computed tomography (CT), who present with a positive elbow extension test and have no evident fracture on x-ray study.

Patients presented to our emergency department with elbow trauma and were evaluated between April 2010 and March 2011. A CT scan of the injured elbow was ordered for patients with pain on elbow extension (a positive elbow extension test) and no evidence of fracture on x-ray study. All CT and x-ray images were evaluated by a designated radiologist.

One hundred and forty-eight patients presented to our emergency department with elbow trauma. Two patients were excluded from the study, one with former motion disability and another with an open fracture. In the remaining patients, there were 32 fractures in total. Forty-three of 114 patients without fracture signs had a positive elbow extension test and 4 of these patients refused CT imaging. Fractures were found in 5 (12.8%) of the 39 patients assessed with CT. CT imaging found that two of these patients had a radial head fracture, two others had an olecranon fracture, and one patient had a coronoid fracture.

We recommend CT as an additional evaluation imaging study for trauma patients who have a positive elbow extension test and who present with no apparent fracture on x-ray imaging.