Best Practice Case Studies-Case 124 Asset 3 Fat Pad Signs in the Elbow

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This article discusses the use of the elbow fat pad sign and alternative radiographic projections to detect occult radial head fractures, which are common in adult elbow trauma but often difficult to see on standard x-rays. The anterior fat pad is normally visible on a correctly positioned lateral elbow image, but if elevated it may create the “sail sign,” suggesting an occult fracture. The posterior fat pad is usually hidden in the olecranon fossa and should not be visible on a proper lateral view; if it is seen, it may indicate injury, though poor positioning can create a false positive.<br /><br />Because traditional AP and oblique views can be hard to obtain in painful or immobilized patients, the article presents three nontraditional axial projections that better show the radial head without superimposition by the ulna. These include a sitting axial lateromedial projection (Coyle method), a recumbent axial lateromedial projection, and a sitting axial mediolateral projection. These methods can be performed with minimal patient movement, with the patient seated or lying down, and are useful in emergency settings, including with portable x-ray equipment.<br /><br />The article emphasizes that technique and proper positioning are critical when evaluating elbow soft tissues and fat pads. While these views may not replace advanced imaging such as MRI or nuclear medicine for occult fractures, they expand the radiographer’s options for demonstrating subtle radial head injuries and may improve diagnostic confidence in traumatized elbows.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 124

Topic Elbow

Keywords

elbow fat pad sign

occult radial head fracture

posterior fat pad

anterior fat pad

sail sign

lateral elbow x-ray

axial projections

Coyle method

elbow trauma

portable radiography

4th Edition

4th Edition, Case 124

Elbow