The Fat Pad Sign Following Elbow Trauma in Adults

O'Dwyer, H.; O’Sullivan, P.J.; Fitzgerald, Deirdre; Lee, MJ; McGrath, F.; Pm, Logan

doi:10.1097/00004728-200407000-00021

Cited by 58 publications

(3 citation statements)

References 8 publications

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“…Studies have shown that 2-10% of proximal femur fractures may be missed on initial radiographs, especially in the trauma setting [5,6]. Unlike other joints, where the presence of an effusion on plain radiograph of the ankle [7] or a displacement of the posterior fat pad in the elbow is informative [8,9], there has yet to be a reliable radiographic sign at the hip to indicate an occult hip fracture. Occult proximal femur fractures can lead to devastating consequences, complicating surgical intervention and comprising ideal outcomes [10].…”

Section: Discussionmentioning

confidence: 99%

Pelvic Shadowing as a Diagnostic Predictor of Orthopedic Pathology in Orthopedic Trauma Patients

Skura¹,

EBAUGH²,

Passias³

et al. 2021

Cureus

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IntroductionThe Throckmorton sign, or John Thomas sign, is a well-established orthopedic eponym, anecdotally used in orthopedic surgery to correlate the direction of male genitalia, observed on a pelvic radiograph, with the laterality of an associated orthopedic pathology. In earlier studies, the direction of pelvic shadowing on Xray has been neither a credible nor a reliable predictor of fracture laterality. Given this small body of evidence, we sought to further investigate the relationship between peri-trochanteric hip fracture laterality and male genitalia lie. MethodA single-center retrospective chart review was conducted of 397 consecutive male patients who received pelvic radiographs performed upon entry to an urban level 1 trauma center. Exclusion criteria included age less than 18 years or a prior history of pelvic or urological surgery. Of this cohort, 360 patients met the inclusion criteria and underwent investigation. ResultsThe study population had an average age of 42 years (range: 18-91 years). Statistical analysis yielded a 4.24 relative risk with pelvic shadowing laterality and respective peri-trochanteric hip fracture sidedness. Additionally, there was a 4.63 and 9.88 relative risk of tibial shaft fractures and distal radius fractures having a concomitant positive Throckmorton Sign, respectively. ConclusionPelvic shadowing can be used as an additional diagnostic tool in predicting peri-trochanteric hip fracture sidedness in a trauma bay setting.

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Section: Discussionmentioning

confidence: 99%

Pelvic Shadowing as a Diagnostic Predictor of Orthopedic Pathology in Orthopedic Trauma Patients

Skura¹,

EBAUGH²,

Passias³

et al. 2021

Cureus

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“…We also observed this fat pad sign on radiographs, especially in cases of elbow trauma (Figure 4). If the first plain radiograph does not show a fracture, indirect signs of fracture should be looked for (17,18). However, a visible anterior fat pad might be normal if it is close to the bone (17).…”

Section: Discussionmentioning

confidence: 99%

“…The term “occult fracture” is defined broadly as a radiographically undetectable or subtle abnormality that has been missed on initial radiographs ( 4 ). The abnormalities which can indicate possible fractures include the fat pad sign because of joint effusion, immobility, stable pressure pain point, and abnormal swelling ( 17 , 18 ). We have not found any previous study that has attempted to determine the prevalence of occult fractures and their clinical significance in children with radiograph-negative AEI and clinical suspicion of fracture.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Significance of Occult Fractures in the Extremities in Children

Jiao

Wang

et al. 2020

Front. Pediatr.

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Objective: Diagnosis of occult fractures by initial plain radiographs remains challenging in children in the emergency room. This study was to assess the prevalence and distribution of occult fracture in children with acute extremities injuries (AEI) and clinical suspicion of fracture. Methods: We conducted a retrospective study to review the medical records of all pediatric patients with AEI in the orthopedic emergency room from January 1, 2017, to December 31, 2019. For patients with concerning history and physical examination but negative initial radiographs, we conducted the following three diagnostic strategies according to the choic of children's parents: immediate MRI scanning, [2] immediate CT scanning, or [3] empiric cast immobilization with orthopedic follow-up radiographs at 2 weeks post-injury (late radiographs). Prevalence and distribution of occult fracture were recorded. Results: A total of 43,560 pediatric patients meet the inclusion criteria. A total of 4,916 fractures of the extremities were confirmed by initial plain radiographs, and 550 occult fractures were confirmed by immediate MRI, immediate CT, or late radiographs. The prevalence of occult fracture in the extremities was 10.1% (550/5,466). Supracondylar fractures were the most prevalent (2,325/5,466, 42.5%) but had the lowest rate of occult fractures (117/2,325, 5.0%). The highest rate of occult fracture was distal epiphyseal fracture of the tibia and fibula (49/145, 33.8%), but these had a relatively lower prevalence of fractures (145/5,466, 2.65%). Conclusions: We should be aware of the relative high prevalence of occult fractures in the extremities in children, especially when the injured site is in the high incidence area of occult fracture such as ankle.

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Elbow Pain in a Child after a Fall

Ward

Baer

2006

Visual Diagnosis in Emergency and Critical Care Medicine

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The Fat Pad Sign Following Elbow Trauma in Adults

Cited by 58 publications

References 8 publications

Pelvic Shadowing as a Diagnostic Predictor of Orthopedic Pathology in Orthopedic Trauma Patients

Pelvic Shadowing as a Diagnostic Predictor of Orthopedic Pathology in Orthopedic Trauma Patients

Prevalence and Clinical Significance of Occult Fractures in the Extremities in Children

Elbow Pain in a Child after a Fall

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