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Elbow CT is Not Needed to Check for Occult Intraarticular Extension in Spiral Distal Third Humeral Shaft Fractures
Harrison Robert Ferlauto, MD
1, John Corvi, MD
1, Pierce Ferriter, BS
2, Ramone Brown, BS
1, Bradford Parsons, MD
1, Jaehon M Kim, MD FAAOS FACS
1, Michael R Hausman, MD
1; Paul J Cagle, MD
1(1)Icahn School of Medicine at Mount Sinai, New York, NY, (2)Icahn School of Medicine, New York, NY
Introduction:
Spiral distal third tibial shaft fractures are known to be associated with occult intraarticular extension in approximately 50% of cases. As such, an ankle CT is routinely obtained for all distal third tibial shaft fractures to check for intraarticular extension. In a similar way, we have noticed a tendency for clinicians to routinely obtain an elbow CT to check for intraarticular extension in spiral distal third humeral shaft fractures (Fig. 1, left). This, however, is despite a lack of evidence for analogous phenomena in the upper extremity. Therefore, the purpose of this study was to determine the incidence of occult intraarticular extension for spiral distal third humeral shaft fractures.
Materials/Methods:
We performed a retrospective chart review of patients who presented to our ER with an acute traumatic spiral distal third humeral shaft fracture between 2010 and 2025. Transverse, mid-shaft, oncologic, and distal humerus fractures were excluded, as were skeletally immature patients. Extracted data included demographics, humerus radiographs, any available elbow CT at the time of injury, and any relevant operative report. The gold standard test for presence of intraarticular extension was either CT scan or direct visualization intraoperatively.
Results:
In total, we identified 141 patients with an acute traumatic spiral distal third humeral shaft fracture. All patients had humerus radiographs. Fifty-nine patients (42%) had an available elbow CT, and an additional 50 patients (35%) had an available operative report. Thus, 109 patients (77%) possessed a gold standard test for intraarticular extension. Of these 109 patients with a gold standard test, four (4%) had extension of the fracture into the elbow joint. However, in all four cases, the intraarticular extension was obvious on initial plain film radiographs (Fig. 1, right). There were no cases of occult intraarticular extension.
Conclusions:
For spiral distal third humeral shaft fractures, the incidence of occult intraarticular extension into the elbow joint approaches 0%. Any rare cases of concomitant intraarticular extension seem to be readily apparent on radiographs alone. Therefore, routinely obtaining an elbow CT to check for occult intraarticular extension in this clinical setting appears unnecessary. Avoiding this additional CT scan can reduce undue cost, radiation exposure, and scanning burden on both the patient and health system.
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