The role of fat pad sign in diagnosing occult elbow fractures in the pediatric patient

Al-Aubaidi, Zaid; Torfing, Trine

doi:10.1097/bpb.0b013e328355e5d8

Cited by 26 publications

(24 citation statements)

References 11 publications

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“…First described by Norel decades ago, but still valid, the only utility of a posttraumatic PFPS was to suspect an occult, nondisplaced fracture about the elbow joint after subtle injury [15][16][17]. However, this sign has one additional interpretation.…”

Section: Discussionmentioning

confidence: 99%

Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method

Samelis

Papagrigorakis²,

Ellinas

2019

Cureus

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The posterior fat pad sign (PFPS) on the lateral elbow X-ray is useful in the diagnosis of a suspected nondisplaced fracture about the elbow after a subtle injury. However, the presence of a PFPS hallmarks a continuous posterior periosteum-posterior capsule of the distal humerus. This anatomic structure is crucial for the stable anatomic reduction of a displaced extension type supracondylar fracture. Subsequently, the presence of a PFPS may predict the successful nonoperative treatment of a Gartland III-type fracture by means of the Blount method, implying less implant-related morbidity and less intraoperative radiation exposure for the patient and surgeon. Furthermore, it is concluded that a PFPS-positive displaced extension type supracondylar fracture is definitively classified as a Gartland III and not a Gartland IV-type fracture. A retrospective study of 75 displaced extension type supracondylar elbow fractures was performed. All fractures had an initial attempt at a closed reduction under general anesthesia. A stable reduction in 120 degrees of elbow flexion without vascular compromise of the affected limb was achieved in 45 fractures, which were splinted in this position. In the remaining 30 cases, fracture reduction was either inadequate or was achieved with excess elbow flexion, which impaired distal blood flow. These fractures were pinned percutaneously and splinted in 90 degrees of elbow flexion. The two treatment groups were retrospectively compared for the presence of a PFPS. The displaced extension type supracondylar fractures, which were treated successfully by the Blount method, had a statistically significant higher prevalence (chi-square-Yates =4.91, p<0.05) of a positive PFPS (28/45 patients, 62.22%) compared to the fractures treated by closed reduction and percutaneous pinning (10/30, 33.33%). No vascular complications were observed. The long-term outcome did not differ between groups.

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Section: Discussionmentioning

confidence: 99%

Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method

Samelis

Papagrigorakis²,

Ellinas

2019

Cureus

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“…8.6 ). A visible fat pad sign without a demonstrable fracture often (but does not absolutely [ 11 ]) indicates an occult fracture in the setting of trauma.…”

Section: Imagingmentioning

confidence: 96%

The Elbow and Forearm: Acquired Disorders

Uhl

2014

Pediatric Orthopedic Imaging

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This chapter fi rst discusses the timing of ossifi cation of the apophyses and epiphyses at the elbow, as an understanding of the appearance of the normal elbow is essential to correct interpretation of the pediatric elbow radiograph. It then discusses fractures that are common in younger children, such as supracondylar, lateral condylar, and medial condylar fractures. It presents radial neck and olecranon fractures, generally encountered in the adolescent period. The many injuries that result from valgus stress are then discussed, including osteochondritis dissecans of the capitellum and medial epicondylar apophysitis. The chapter concludes with a presentation of osteochondrosis of the capitellum (Panner disease).Fractures and overuse injuries are common in the pediatric elbow. Supracondylar, lateral condylar, and medial condylar fractures are especially common in younger children, often due to falls. After these centers fuse, physeal injuries no longer occur; radial neck fractures and olecranon fractures become more common in the adolescent period. Repetitive valgus stress-such as occurs in pitchers and other throwing athletesmay lead to osteochondritis dissecans of the capitellum, apophysitis of the medial epicondyle or olecranon, loose bodies, and growth disturbances.

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“…According to some literature, this percentage ranges from 10% to 89%. 33,34 Regardless of the available literature, in daily clinical practice it is fairly standard to apply a long arm cast or a splint in the presence of an isolated posttraumatic elbow joint effusion. 32,34 The lack of a fat pad sign, however, does not exclude a fracture because parts of the medial and lateral epicondyles and the radial neck are extracapsular structures; thus fractures of these structures do not necessarily cause a joint effusion.…”

Section: Normal Elbow Developmentmentioning

confidence: 99%

Pediatric Musculoskeletal Trauma: Upper Limb

Restrepo

Cervantes

Zahrah

et al. 2021

Semin Musculoskelet Radiol

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Pediatric upper extremity injuries, acute and chronic due to overuse, are commonly encountered in the clinical setting. However, interpretation of imaging studies is often challenging in pediatric patients because of changing postnatal skeletal development and the broad spectrum of pathology that can potentially occur. This article discusses normal skeletal development and the pathomechanics of skeletal injuries in pediatric patients. It also outlines a framework for imaging as it pertains to the pediatric upper extremity, with specific emphasis on acute and chronic injuries to the shoulder, elbow, forearm, and wrist.

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The role of fat pad sign in diagnosing occult elbow fractures in the pediatric patient

Abstract: Level III, development of diagnostic criteria on the basis of consecutive patients.

Cited by 26 publications

References 11 publications

Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method

Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method

The Elbow and Forearm: Acquired Disorders

Pediatric Musculoskeletal Trauma: Upper Limb

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