consecutive patients whose posttrauma elbow radiographs showed an effusion but no fracture and who were suitable for MR imaging were recruited. The elbow effusion size represented by anterior and posterior fat pad displacement was measured from the initial lateral elbow radiograph. Suitable candidates underwent MR imaging using a bone marrow sensitive sequence. The time between injury and MR ...
The fat pad is indicated by the white arrows. On the zoomed image on the bottom left the pronator quadratus muscle is coloured red and the fat pad in yellow. The top right image is from a patient in his twenties who fell on his outstretched hand. There is a subtle fracture with some buckling of the posterior cortex of the distal radius ...
2 However when the elbow joint capsule becomes distended eg. hemarthrosis secondary to a fracture within the joint space the anterior fat pad is displaced further anteriorly and superiorly to form an anterior quotsail signquot or a more prominent lucency. c The posterior fat pad normally lies over the olecranon fossa.
Quick diagnosis of occult fracture of elbow by knowledge of anterior fat pad sign sail sign posterior fat pad sign anterior humeral line radiocapitellar line ossification centres of elbow.
The sail sign on an elbow radiograph describes the elevation of the anterior fat pad to create a silhouette similar to a billowing spinnaker sail from a boat. It indicates the presence of an elbow joint effusion.
Although fat pad signs are classically associated with fracture there are many nontraumatic disease processes which lead to positive fat pad signs. Any intraarticular fluid or tissue accumulation may result in an abnormal posterior fat pad. A 39paradoxical39 positive posterior fat pad sign may occur in some instances of extraarticular disease.
The anterior fat pad is a summation of the radial and coronoid fat pads which are normally pressed into the shallow radial and coronoid fossae by the brachialis muscle during extension. The posterior fat pad is normally pressed into the deep olecranon fossa by the triceps brachii tendon and anconeus muscle during flexion and the third lies ...
The posterior fat pad sign has been reported as a reliable sign of an elbow joint effusion 123 5. However the presumed incidence of a fracture has varied widely in both the radiologic and orthopedic literature.
Raised fat pad sign. If the anterior fat pad is raised away from the humerus or if a posterior fat pad is visible between triceps and the posterior humerus then this indicates a joint effusion. In the setting of trauma this is due to haemarthrosis blood in the joint secondary to a bone fracture. This is often the only Xray sign of a bone ...
The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone J Surg 19998114291433. Labels Emergency MSK Radiography Signs in Radiology Trauma
The anterior fat pad displacement ranged from 5 to 15 mm mean 9.25 and the posterior fat pad was elevated from 1 to 6 mm mean 3.2. Conclusion Our data using MR imaging suggests that fat pad elevation in the presence of recent trauma is frequently associated with a fracture.
Murphy WA Siegel MJ. Elbow fat pads with new signs and extended differential diagnosis. Radiology 1977124659665. Harris JH Jr Harris WH. The Radiology of Emergency Medicine. Baltimore Williams amp Wilkins 1975181. Bledsoe RC Izenstark JL. Displacement of fat pads in disease and injury of the elbow A new radiographic sign. Radiology 1959 ...
DISCUSSION The value of the fat pad sign in identifying patients with elbow fractures has been proven time and again but it is not perfect. In a recent study 20 adult elbow trauma cases with positive fat pad signs but no identified fractures underwent MRI scans within 0 to 12 days 18 .
Elbow Radiograph Lateral projection. 1 Humerus. 5 capitulum. 6 Radius. 7 Radial head. 8 Ulna. 9 Olecranon. 10 Coronoid process of ulna. 11 Lateral radiograph shows a positive fat pad sign in a patient with a nondisplaced fracture of the radial head. The anterior lucency represents the elevated anterior fat pad sign.
Similarly the posterior fat pad sign is a welldemarcated lucency posterior to the distal humeral metaphysis and its presence is always pathologic. Displacement of these fat pads produced by an intraarticular effusion or hemarthrosis resembles the spinnaker on a sailboat and is referred to as the sail sign .
The fat pad sign first reported in 1954 is a reliable marker for elbow joint effusion and raises suspicion for fracture in the setting of trauma . The posterior humeral fat pad is situated in the intercondylar depression of the distal humerus and is not visible on a normal lateral elbow radiograph.
Elbow Fat Pad Sign.OrthopaedicsOne Articles.In OrthopaedicsOne The Orthopaedic Knowledge Network.Created Jan 06 2008 1427. Last modified Sep 06 2008 0650 ver. 6. ...
Radial head fracture Fat pads Lateral. This is the commonest elbow fracture in adults The fracture line is not visible on the lateral view in this case The effusion indicated by raised fat pads is the only visible sign of injury and in the context of trauma should be taken to indicate an undisplaced intracapsular fracture
Elbow Checklists 1 Radiographic examination AP External oblique Lateral 2 Elbow joint effusions and the fat pad sign Visible posterior fat pad Elevation of the anterior fat pad the sail sign 3 Common sites of injury in adults Radial head and neck Olecranon Coronoid process of ulna Distal humerus 4 Common sites of injury in
The anterior fat pad sign should be taken as hard evidence of trauma necessitating careful scrutiny and high level of suspicion.
Anterior and posterior fat pad signs in a case of an undisplaced fracture of the radius head which is not visible directly. A normal anterior fat pad in a nonfractured arm. Anterior quotSail signquot
A falsenegative fat pad sign of the elbow may occur if there is poor positioning of the elbow true lateral is best extracapsular abnormality e.g. massive softtissue swelling around the joint or capsular rupture. A falsepositive fat pad sign of the elbow can be seen with elbow extension.
Elbow Fat Pad Sign A. Normal lateral radiograph of the elbow. B. Plain film radiograph of the lateral elbow which reveals the classic elbow fat pad sign. This is an invaluable soft tissue finding in cases of intraarticular injury of the elbow. Fat is normally present within the joint capsule of the elbow but outside the synovium.
The fat pad sign following elbow trauma in adults its usefulness and reliability in suspecting occult fracture. O39Dwyer H1 O39Sullivan P Fitzgerald D Lee MJ McGrath F Logan PM. Author information 1Department of Radiology Beaumont Hospital Dublin Ireland.
The fat pad sign is invaluable in assessing for the presence of an intraarticular fracture of the elbow. An anterior fat pad is often normal. However a posterior fat pad seen on a lateral xray of the elbow is always abnormal. The patient will be unable to flex their elbow and requires orthopaedic input. Pathophysiology. The posterior fat pad ...
The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Joint Surg Am 1999 8114291433. Medline Google Scholar 8 de Beaux AC Beattie T Gilbert F. Elbow fat pad sign implications for clinical management. J R Coll Surg Edinb 1992 37205206. Medline Google Scholar
that a fat pad sign may demonstrate a false positive if the lateral has been improperly positioned. Proper positioning requires 90 flexion of the elbow joint. Other angles may tempt the posterior fat pad to emerge from the olecranon fossa mimicking the fat pad sign. Therefore in a noninjured correctly positioned lateral elbow the ...