Nondisplaced elbow fractures: A commonly occurring and difficult diagnosis

Purpose Determine the sensitivity and specificity of radiography in identifying nondisplaced elbow fractures after trauma. Our hypothesis is that nondisplaced fractures occur commonly following impact injuries and are difficult to diagnose with plain film imaging. Methods An in vitro double-blinded study of 16 cadaver arms was designed, simulating axial forearm trauma. Following injury, anteroposterior and lateral radiographs were obtained. Each specimen was dissected, and the injury described. A musculoskeletal radiologist, blinded to dissection results, examined the radiographs. Results Dissection revealed 39 fractures of 96 sites examined. A total of 14 fractures were nondisplaced, 7 involving the coronoid process. Radiographs identified 27 fractures. Of the 12 missed fractures, 11 were nondisplaced. Radiographic diagnosis of nondisplaced elbow fractures demonstrated a 21% sensitivity, 95% specificity, 50% positive predictive value, and 83% negative predictive value. Conclusions Radiography for nondisplaced elbow fractures demonstrated limited success. Additional imaging studies may be required in suspected elbow injuries with initial negative radiographs.