Elbow (Coyle's view)

The Coyle's view of the elbow is an axial projection that is performed in addition to the standard elbow series when there is suspicion of a radial head fracture ^1-3.

Indications

The Coyle's view is performed for any patient with a suspected radial head fracture or dislocation. It is effective in patients who are unable to extend their arm fully and isolates the radial head using a modified radiographic technique.

Patient position

• patient is sitting next to the table
• at 90 degrees elbow flexion, the medial border of the palm and forearm are kept in contact with the tabletop
• the shoulder, elbow and wrist are kept in the same horizontal plane
• rotate the hand so the thumb is pointing towards the ceiling, ensuring all aspects of the arm from the wrist to the humerus are in the same plane
• the beam is angled roughly 45 degrees towards the long axis of the humerus

Technical factors

• axial projection
• centring point
  • the radial head
• collimation
  • superior to distal third of the humerus
  • inferior to include the entity of the radial head
  • anterior to include the skin margin
  • posterior to skin margin
• orientation
  • landscape
• detector size
  • 18 cm x 24 cm
• exposure
  • 55-65 kVp
  • 3-6 mAs
• SID
  • 100 cm
• grid
  • no

Image technical evaluation

• the radial head should be almost free from superimposition projected away from the ulna
• the radial head is slightly elongated

Practical points

Tight collimation, although important, should not clip off critical anatomy, ensure when collimating for this projection you favour the radial aspect of the elbow.

Because you are using a steep angle, remember to adjust your exposure accordingly.