TRASH (The Radiographic Appearance Seemed Harmless) Lesions About the Elbow

Abstract

In adults, fractures of the distal humerus, proximal radius, and olecranon are easily identified radiographically. In contrast, for children there exists a small subset of fractures that are challenging to identify due to the lack of ossification of the elbow epiphyses. These osteochondral fractures often appear benign on plain radiographs, as the main portion of the fracture is cartilaginous in nature. As they are difficult to identify radiographically and thus are easily missed, they are commonly referred to as “TRASH” lesions (The Radiographic Appearance Seemed Harmless). These injuries can require three-dimensional imaging to better characterize the lesion. TRASH lesions are relatively rare fractures that occur in skeletally immature children. They can include unossified medial condyle fractures, unossified transphyseal distal humerus fractures, entrapped medial epicondyle fractures, complex osteochondral elbow fracture dislocations, osteochondral fractures with joint incongruity, radial head compression fractures with radiocapitellar subluxation, Monteggia fracture dislocations, and lateral condyle avulsion shear fractures (Waters PM, Beaty J, Kasser J (2010) J Pediatr Orthop 30(Supp 2):S77–S81). Failing to diagnose these fractures can lead to devastating consequences in regard to the future health of the elbow.