Radial head fracture with posterior fat pad sign

Case contributed by Nauman Akram
Diagnosis almost certain

Presentation

Fall off a bike. Complaining of elbow pain

Patient Data

Age: 25 years
Gender: Male

The lateral film demonstrates anterior elevation of the anterior fat pad and a visible posterior fat pad. There is no fracture on the lateral view.

The oblique view shows a small fracture of the radial head.

 

Case Discussion

Normally the posterior fat pad should not be seen at all and the anterior fat pad should be located adjacent to the anterior humeral cortex.  The positive fat pad sign indicates a joint effusion and in the context of trauma should raise suspicion of hemorrhage due to fracture. In the adult patient one must consider a radial head fracture and in a child supracondylar fracture. 
Remember that if there is acute trauma on a background of a prior history of joint pathology, e.g. rheumatoid arthritis, then a joint effusion may not be due to a fracture and be a red herring.

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