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Elbow TRASH (the radiographic appearance seemed harmless) lesions

Paediatric elbow radiographs pose a particular challenge to orthopaedic surgeons as the non-ossified regions are poorly visualized on plain radiographs of very young children. Therefore, a high index of suspicion must be maintained when a young child presents with a swollen and painful elbow, yet the Xrays do not reveal any obviously displaced fractures. There are eight injuries that have been labelled “TRASH” lesions – “The Radiographic Appearance Seemed Harmless”. Elbow radiographs need to be examined closely for malalignment, displaced flecks of bone which may be attached to larger osteochondral fragments, and asymmetry when compared with the contralateral elbow. MRI provides the best anatomical detail and can help plan appropriate management. If timely diagnosis is not made or the injury is not managed properly, severe complications may arise such as growth disturbance, inadequate reduction of intra-articular fragments, and persistent malalignment of the elbow joint.