Answer for BIR CoW 09 Feb 2025
Radial head fracture of left elbow with anterior fat pad sign.
Findings
Evidence of fracture noted in Radial head with mild dislocation. Anterior fat pad is elevated- Anterior fad pad sign/ sail sign.
Discussion
Radial head fractures are the most common elbow fractures. Fracture line may be subtle and easily overlooked on Radiographs. So one must search for various signs that indicate an occult fracture. Fat –pad Sign: A useful sign of an intra- articular fracture of the elbow, based on displaced humeral capsular fat pads. Sail sign or anterior fat pad sign: it describes the elevation of anterior fat pad . The anterior fat pad is usually concealed within the coronoid fossa, paralleling anterior humeral line. When there is joint effusion, the anterior fat pad is elevated .In the context of acute trauma, where an anterior fat pad is raised and no fracture is demonstrated ,suspect for occult fracture. Posterior fat pad sign: Visualisation of a lucent crescent of fat located in the olecranon fossa. Normally ,the posterior fat pad will not be seen. In setting of trauma, demonstration of this sign, suggests an occult non displaced fracture. In children it most often indicates a supracondylar fracture. Fracture line: A radiolucent line is seen usually oriented vertically and penetrating the articular cortex toward the lateral side of the head. Cortical disruption: At the fracture site, the cortex will be broken. Cortical Deformity: At the fracture site, a sharp step-off or angulation is common, owing to fragment displacement. Double cortical sign: In Depression of the fracture ‘s fragment , this sign seen as a linear opacity paralleling the normal articular cortex of the radial head. Altered Supinator fat line: On a normal lateral film, a linear radiolucent line representing the outer fascial plane of supinator muscle , 1 cm above the anterior radial surface, will be seen. In Fractures of radial head this line may be obliterated.
References: Helms CA. Fundamentals of skeletal radiology. W B Saunders Co. (2005) ISBN:0721605702. Yochum and Rowe ‘s Essentials of Skeletal Radiology
Findings
Evidence of fracture noted in Radial head with mild dislocation. Anterior fat pad is elevated- Anterior fad pad sign/ sail sign.
Discussion
Radial head fractures are the most common elbow fractures. Fracture line may be subtle and easily overlooked on Radiographs. So one must search for various signs that indicate an occult fracture. Fat –pad Sign: A useful sign of an intra- articular fracture of the elbow, based on displaced humeral capsular fat pads. Sail sign or anterior fat pad sign: it describes the elevation of anterior fat pad . The anterior fat pad is usually concealed within the coronoid fossa, paralleling anterior humeral line. When there is joint effusion, the anterior fat pad is elevated .In the context of acute trauma, where an anterior fat pad is raised and no fracture is demonstrated ,suspect for occult fracture. Posterior fat pad sign: Visualisation of a lucent crescent of fat located in the olecranon fossa. Normally ,the posterior fat pad will not be seen. In setting of trauma, demonstration of this sign, suggests an occult non displaced fracture. In children it most often indicates a supracondylar fracture. Fracture line: A radiolucent line is seen usually oriented vertically and penetrating the articular cortex toward the lateral side of the head. Cortical disruption: At the fracture site, the cortex will be broken. Cortical Deformity: At the fracture site, a sharp step-off or angulation is common, owing to fragment displacement. Double cortical sign: In Depression of the fracture ‘s fragment , this sign seen as a linear opacity paralleling the normal articular cortex of the radial head. Altered Supinator fat line: On a normal lateral film, a linear radiolucent line representing the outer fascial plane of supinator muscle , 1 cm above the anterior radial surface, will be seen. In Fractures of radial head this line may be obliterated.
References: Helms CA. Fundamentals of skeletal radiology. W B Saunders Co. (2005) ISBN:0721605702. Yochum and Rowe ‘s Essentials of Skeletal Radiology
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!