What does a fat pad sign mean (in children)?

27 Nov

585px-Fettpolsterzeichen_pathologisch_Ellenbogen-1

Clinical scenario

A 7 year old girl is presented at the accident and emergency department after a fall during gymnastic exercises. She fell down from an apparatus with outstretched arms and now complains of a painful left elbow. Her left elbow is painful and swollen. She is unable to bend or stretch it. On X-ray no fractures were seen but the ventral en dorsal fat pad sign were positive. Is there an occult fracture?

Introduction

A fat pad sign is seen on a lateral elbow x-ray and is caused by the displacement of fat by fluid usually caused with trauma but can be caused by infection and malignancies. According to the literature there is no consensus on the percentage of fractures with a positive fat pad sign it varies considerably between 17-89%.

Methods:

A literature search was conducted in the databases of PUBMED and TRIP using combined search terms for elbow and fat pad. The search yielded a total of 95 articles after deleting the doubled articles 56 articles were left of these the title and abstract were read and after exclusion for review articles animal studies and articles in other languages than English, Dutch, German or French. Articles were appraised selecting for validity. Studies were included if they included children and compared x-ray to another diagnostic modality like MRI or ultrasonography.

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