Imaging humeral fractures.

521 RADIOLOGIC TECHNOLOGY July/August 2007, Vol. 78/No. 6 Radiologic technologists commonly are called to emergency departments to image the humerus. In the United States humeral fractures represent 4% to 5% of all fractures. Corby described fracture patterns in the humerus as being about the same regardless of age; however, older patients with osteoporosis are more susceptible to these types of fractures. The mechanism of injury can be either a disease process or trauma, and a pathologic fracture can be as challenging to image as a fracture caused by a fall on an outstretched arm. Additionally, severe trauma such as a gunshot wound to the arm can be enormously challenging for the radiographer (see Figure 1). Regardless of the mechanism of injury, several projections have been described to help radiographers image humeral fractures. These include the anteroposterior (AP), commonly referred to as external rotation; lateral or internal rotation; axillary; scapular “Y”; and transthoracic projections of the shoulder. Each of these projections has been described in radiographic positioning textbooks and should be a part of a seasoned radiographer’s repertoire. The AP is relatively easy to perform and frequently requires placing the imaging receptor (IR) diagonally to ensure inclusion of both joints. In a true AP of the humerus, the epicondyles of the distal humerus are placed equidistant from the IR, and the central ray (CR) is directed to the mid-diaphysis of the humerus. The lateral projection is performed in the same manner, but the arm is internally rotated, placing the epicondyles of the distal humerus perpendicular to the IR. The advantage of these 2 methods is that they can be performed with the patient either recumbent Imaging Humeral Fractures