Trash elbow lesions

TRASH (The Radiographic Appearance Seemed Harmless) comprises osteochondral fractures and subtle radiographic elbow bone and joint malalignment injuries. These are commonly seen in children. They may be epiphyseal separations, a displaced intra-articular unossified medial condyle, capitellar shear fracture, radial head fracture with radiocapitellar subluxation, and osteochondral fractures of olecranon, radial head, or distal humerus with joint incongruity. A history of high-energy trauma in a child, with the clinical finding of a massive elbow swelling but with an almost normal radiographic picture, should always arouse suspicion. Other diagnostic modalities including ultrasound, arthrograms, and ideally MRI scans are required to allow an early diagnosis and prompt treatment. Long-term complications include avascular necrosis, heterotopic ossification, periarticular contractures, and subluxation, ultimately leading to permanent malalignment, limited motion, premature osteoarthritis, and poor function.