Positive Fat Pad Sign Research Articles

Occult Fractures in Children with a Radiographic Fat Pad Sign of the Elbow: A Meta-Analysis of 10 Published Studies.

A radiographic fat pad sign after an elbow injury in children may indicate an occult fracture. Different incidences and locations of occult fractures have been reported. The primary objective of this meta-analysis was to assess the overall rate of occult fractures in children with a positive fat pad sign from the data of original studies. Secondary objectives were to assess the fracture types and to identify risk factors for sustaining an occult fracture. A systematic literature search of the Embase, MEDLINE, and Cochrane databases was performed according to PRISMA guidelines. Studies on pediatric populations with a positive fat pad sign identified using a lateral elbow radiograph and with follow-up imaging were included in this meta-analysis. Included studies were assessed for risk of bias with use of the MINORS (Methodological Index for NOn-Randomized Studies) instrument. Ten studies with a total of 250 patients, of whom 104 had an occult fracture, were included. Accounting for heterogeneity between the studies, the overall occult fracture rate was 44.6% (95% confidence interval: 30.4% to 59.7%). The most common fracture locations were the supracondylar humerus (43%), proximal ulna (19%), proximal radius (17%), and lateral humeral condyle (14%). Definitions of a positive pad fad sign were not uniform among studies, and the follow-up imaging modality also varied (radiography, magnetic resonance imaging, or computed tomography). The average MINORS score was 10.1 for the 7 noncomparative studies and 18.7 for the 3 comparative studies, with both averages classified as moderate quality. We were not able to identify risk factors for an occult fracture in the presence of a positive fat pad sign. The occult fracture rate was 44.6% in pediatric elbow injuries with a positive fat pad sign. Supracondylar humeral fractures were the most frequently encountered type. The findings of this meta-analysis underline the potential clinical relevance of a positive fat pad sign in children and denote the opportunity for future studies to create evidence-based guidelines. Level II. See Instructions for Authors for a complete description of levels of evidence.

Sonographic fracture diagnostics

In clinically suspected fractures taking radiographs is the standard procedure but the indications should be strictly limited. Ultrasound offers a safe and radiation-free alternative for fracture diagnostics. Sensitivity and specificity of sonographic fracture diagnostics and safety of sonographic algorithms for fracture evaluation. Presentation of useful applications for sonographic fracture evaluation and establishment of sonographic algorithms for safe fracture diagnosis. In children distal forearm fractures can be diagnosed solely by ultrasound (sensitivity 96 % and specificity 97 %). The sonographic fat pad sign (SOFA) has been proven to be a useful primary screening tool for occult fractures of the pediatric elbow. A positive fat pad sign (SOFA+) is indicative of a fracture and radiographic diagnostics are necessary (sensitivity 97 % and specificity 91 %). Ultrasonography is also useful to exclude subcapital humeral fractures (sensitivity 94 % and specificity 100 %) and for correct estimation of displacement when present. Sonographic algorithms for fracture evaluation (SAFE) offer a safe diagnosis and guidance of the therapeutic course of certain pediatric fractures, thereby reducing unnecessary radiation exposure.

Fraktursonografie im Kindesalter

X-rays are the standard imaging procedure for the diagnosis of pediatric long bone fractures. Recent studies show that ultrasound (US) imaging is also qualified to diagnose pediatric long bones fractures. Thus, the diagnosis and decision-making for the treatment of metaphyseal forearm fractures in children can be performed by solely using US. The sonographic fat pad sign has been proven to be a useful primary screening tool for pediatric elbow injuries. If there is a negative fat pad sign, a fracture is unlikely and taking additional radiographs is dispensable at this time. If there is a positive fat pad sign, a fracture is likely and radiographs should be taken. US is also useful to exclude subcapital humeral fractures and to estimate fracture displacement. If a fracture of the subcapital humerus is present, additional radiographs are necessary to avoid overlooking of pathologic fractures. For reliable sonographic fracture diagnosis in childhood, a detailed history und exact clinical examination are required.

Ultrasound evaluation of elbow fractures in children.

Elbow fractures are a common pathology in any pediatric emergency unit. X-ray of the elbow is the standard diagnostic procedure. Previous studies have shown that fractures can also be visualized by ultrasound (US). The aim of our study was to evaluate the diagnostic accuracy of US in comparison to X-rays in diagnosing pediatric elbow fractures. Sixty-seven patients aged 1-13years with clinically suspected elbow fracture were first examined by US followed by standard two-plane radiographs. US examination was done with a 12-MHz linear probe from seven longitudinal positions across the distal humerus and additionally from longitudinal positions across the radial head and olecranon. The sonographic and radiological findings were compared in a contingency table, and sensitivity, specificity, and positive and negative predictive values of the US diagnostic procedure were calculated. With X-ray, we found 48 patients with an elbow fracture and 19 patients with no fracture. With US, we found 46 patients with an elbow fracture and 21 patients with no fracture. In comparison to X-ray diagnosis, we calculated for US diagnosis a sensitivity of 97.9%, a specificity of 95%, a negative predictive value of 95%, and a positive predictive value of 97.9%. Typical elbow fractures in children could also be visualized by US. A positive fat pad sign, in particular, serves as a strong indicator for elbow joint fractures and can be identified very sensitively by US. We confirm US as a valuable primary screening tool for elbow injuries in children. In the absence of US signs of fracture and in sonographically confirmed non-displaced fractures, standard X-rays are dispensable, thereby minimizing the X-ray burden in children without loss of diagnostic safety.

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

In 1954, Norell described the 'fat pad sign' for the first time. This refers to the radiological visualization of the elbow fatty tissue. This is a prospective study with the aim of clarifying the relation between the presence of a positive fat pad sign on the lateral radiograph and the type of injury verified on MRI. From January to December 2010, 31 children were diagnosed primarily with a positive fat pad sign. An above-the-elbow cast was applied and all patients were referred for an MRI within a few days. All patients were recommended a clinical follow-up and informed about the MRI results. After revision, five patients were found to have a negative fat pad sign and were excluded. This resulted in a total of 26 patients, 10 men and 16 women, mean age 10±2.62 years. The time between the injury and the initial radiological examination was 0.8±0.27 days and the MRI was obtained on an average of 6.6±3.84 days. A total of 12 patients had an injury of the left side and 14 of the right side. The MRI showed a posterior positive sign in all except five cases and six occult fractures, which accounts for 23%. Nineteen patients (73%) had a bone bruise. All patients except one had a normal range of movement with no pain on the last clinical examination after 2-3 weeks. The presence of a positive fad pad sign is not synonymous with occult fractures. Finding occult fractures on MRI does not alter the final treatment of these patients. On the basis of this study and review of other similar studies, pediatric patients who presented with elbow effusion verified on conventional radiographs could be treated with a cast for 2-3 weeks and extra clinical or radiological controls did not seem to be indicated. Level III, development of diagnostic criteria on the basis of consecutive patients.

Treatment of early-acute osteomyelitis in childhood: brief report.

VOL. 69-B, No. 5, NOVEMBER 1987 Discussion. We agree with most other observers that positive fat pad signs indicate an effusion. In our series the presence of an effusion without a fracture on the initial radiograph equated with a rapid return to normal function. In only six cases was the effusion the only sign of a fracture which became apparent later, compared with the 45 patients with an effusion who had no demonstrable fracture even later. We therefore suggest that in patients who have injured the elbow a positive fat pad sign in isolation is not pathognomonic of a fracture and that unless there are any clinical indications the finding can be ignored.

Radiographic clues to fractures of the unossified medial humeral condyle in young children.

A fracture involving the trochlear ossification center as well as the medial epicondyle is a more serious injury than simple avulsion of the medial epicondyle. This diagnosis may be difficult in young children before the secondary centers are ossified. Radiographic clues to this injury in a young child are localized soft tissue swelling over the medial aspect of the elbow accompanied by a metaphyseal flake and/or a positive fat pad sign. In the older child, separation of the ossified medial epicondyle with a positive fat pad sign suggests a more complex injury.

Elbow fat pads with new signs and extended differential diagnosis.

Although fat pad signs are classically associated with fracture, there are many nontraumatic disease processes which lead to positive fat pad signs. Any intraarticular fluid or tissue accumulation may result in an abnormal posterior fat pad. A "paradoxical" positive posterior fat pad sign may occur in some instances of extraarticular disease. An extended differential diagnosis is presented.

Swollen Elbow Following Trauma

<h3>History</h3> A WOMAN was seen in the emergency room following a fall. She complained of pain in the elbow. Examination demonstrated swelling of the elbow with a decreased range of motion. Roentgenograms were obtained (Fig 1 and 2). <h3>Diagnosis</h3> Fracture of the elbow with positive fat pad sign. <h3>Comment</h3> The lateral roentgenogram of the elbow (Fig 1) shows two soft-tissue curvilinear radiolucencies, one projecting anterior to and the other posterior to the distal area of the humerus just above the elbow joint. Neither the anteroposterior nor the lateral view shows a fracture. The lucent shadows represent the fat pads overlying the distal area of the humerus, displaced by fluid in the elbow joint. Fat pads are often seen on the lateral roentgenogram of the flexed elbow in a patient who has had recent trauma, and are generally associated with a fracture. In most cases, the fracture is apparent radiographically, and

The positive elbow fat pad sign in rheumatoid arthritis.

THE POSITIVE ELBOW FAT PAD SIGN IN RHEUMATOID ARTHRITISROGER J. JACKMAN, M.D. and DAVID G. PUGH, M.D.Audio Available | Share