Radiographs Forearm

Bone mineral density can be measured at various sites throughout the skeletal system and by various methods. The site of measurement can be either central (hip and/or spine) or peripheral (heel, forearm, or hand). Dual-energy x-ray absorptiometry (DXA) can be used to measure central and peripheral sites of bone mineral density. Quantitative ultrasound, peripheral quantitative computed tomography, radiographic absorptiometry, and single-energy x-ray absorptiometry are used to measure peripheral sites. 

OI type V is now widely recognized as a distinct OI phenotype with characteristic clinical and radiological features, such as predisposition to formation of hypertrophic callus at sites of fractures or surgical interventions, early calcification of the interosseous membrane of the forearm, and appearance of dense metaphyseal bands in radiographs. Patients have moderate... 

In adults receiving long-term parenteral nutrition, despite its anabolic effects on other tissues, there is no improvement in bone density. Infants treated with parenteral nutrition from birth also develop low bone density for age, suggesting that parenteral nutrition treatment in some way contributes to the osteopenia (5). A 17% long-term increase in spinal bone mineral content has been shown in patients who have received parenteral nutrition solntions without vitamin D. However, this rise was nearly balanced by a 15% fall in hip bone mineral content (115). In a Danish study of bone mineral content in adults receiving home parenteral nutrition for short bowel syndrome, despite the fact that all were on free oral intake as a supplement to the parenteral nutrition, 47% had mandibular osteoporosis while 33% had osteoporosis in the forearm and radiographic changes of osteoporotic fractures in the vertebral column. Dental and periodontal tissues were normal (116). 

Fig. 9.11. Anteroposterior radiograph of forearm. In the supinated position, the bicipital tuberosity of the radius points towards the ulna. The convexity of the bowed radius points away from the ulna...

Inclusion of the wrist and elbow in radiographs of forearm fractures is mandatory to exclude associated injuries to these joints (see Monteggia/Galeazzi). One pitfall in interpreting forearm radiographs is to misdiagnose the nutrient artery as an undisplaced fracture. This vessel maybe visualised on the AP radiograph at the junction of the proximal and middle third of the radius. It has a distal entrance point and runs obliquely in a proximal direction. 

For all children having an injury to the elbow, the two standard views that should be obtained are the anteroposterior (AP) view with elbow fully extended and the forearm fully supinated (if possible). The other view is the lateral with the elbow at 90 of flexion and the forearm in neutral position. Comparison views of the other elbow should not be part of normal radiographic practice and should only be performed in exceptional circumstances, because of the radiation exposure to the child. 

In addition to AP and lateral radiographs, the child may complain of referred pain in the wrist and increased tenderness on forearm supination/prona-tion. 

The most common complication, seen in up to 40% of children, is a loss of forearm pronation, and to a lesser extent, a loss of supination. This is probably due to the formation of an incongruous joint and the formation of flbrous scar tissue about the radial head. Radial head overgrowth, secondary to increased epiphyseal growth, may be seen on radiograph but does not seem to cause functional impairment. 

Rogers LF, Malave S Jr, White H, Tachdjian MO (1978) Plastic bowing, torus and greenstick supracondylar fractures of the humerus radiographic clues to obscure fractures of the elbow in children. Radiology 128 145-150 Roposch A, Reis M, Molina M, Davids J, Stanley E, Wilkins K, Chambers HG (2002) Supracondylar fractures of the humerus associated with ipsilateral forearm fractures in children a report of forty-seven cases. J Pediatr Orthop 21 307-312... 

Fig. 5. Radiograph of forearm fracture treated with cfr epoxy plate. Note the radio-transparency of the plate.

Fig. 8.33a-d. Calcified bicipitoradial bursitis in a woman with chronic renal failure who presented with a palpable mass in the antecubital fossa and difficulties in pronation, a Photograph shows focal soft-tissue swelling (arrowheads) over the anterior proximal forearm, b Transverse and c longitudinal 12-5 MHz US images reveal extensive hyperechoic deposits (arrows) with faint posterior acoustic shadowing related to calcifications with the bicipitoradial bursa. The bursa exhibits thickened walls and the distal portion of the biceps tendon (T) is completely surrounded by calcifications, d Correlative lateral radiograph shows the bulk of calcifications (arrows) in the antecubital fossa... 

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