Q: THE POSITIVE FAT-PAD SIGN: WHAT IS IT?

March 1 2003 Terry R. Yochum, Chad J. Maola
Q: THE POSITIVE FAT-PAD SIGN: WHAT IS IT?
March 1 2003 Terry R. Yochum, Chad J. Maola

A useful sign of an intraarticular fracture of the elbow is the clear depiction of displaced humeral capsular fat-pads.' In the normal elbow, a layer of fat ("fat-pad") lies between the synovial and fibrous layers of both the anterior and posterior joint capsules. In the lateral projection of the normal elbow, the anterior fat-pad is seen as an obliquely oriented radi-olucency. When acute intracapsular swelling is present from any origin (hemorrhagic, inflammatory, or traumatic), the anterior fat-pad is elevated to be oriented horizontally, while the posterior fat-pad, when visible, is the most reliable sign of intraarticular effusion. In children and adolescents, 90% of posterior fat-pad signs will have an associated frac­ture.1 In adults the sign is less frequently seen, and its absence does not exclude the presence of a fracture." •' BW3 See References on Page 59 Dr. Terry R. Yochum is a second-generation chiropractor and a cum laude graduate of the Na­tional College of Chiro­practic, where he subse­quently completed his ra­diology specialty. He is currently Director of the Rocky Mountain Chiro­practic Radiological Center, in Denver, CO, an Adjunct Professor of Ra­diology at the Los Ange­les College of Chiroprac­tic, as well as an instruc­tor of Skeletal Radiology at the University of Colo­rado School of Medicine, Denver, CO. Dr. Yochum is, also, a consultant to Health Care Manufactur­ing Company that offers a Stored Energy system. For more information, Dr. Yochum can be leached at: (S03) 940-9400 or by e-mail at [email protected] Dr. Chad Maola is a 1999 Magna Cum Laude Graduate from National College of Chiropractic. Figure 1. Observe the displacement of the posterior fat-pad from the olecranon fossa (arrow). This usually indicates a hidden fracture Figure 2 and Figure 3. There is an impaction fracture of the neck of the radius (arrow). This patient fell on outstretched hand, locked her elbow and had a positive fat-pad sign.