the role of fat pad sign in diagnosing occult elbow ... · the role of fat pad sign in diagnosing...
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Orthopaedic and Radiological Research Unit – Dept. of Orthopaedic Surgery and Traumatology and Dept. of Radiology
Odense University Hospital Institute of Clinical Research – University of Southern Denmark
The role of Fat Pad sign in diagnosing occult elbow fractures in the pediatric
patient; A prospective MRI study
Zaid Al-Aubaidi, Trine Torfing, Niels W Pedersen, Torben Stryhn Odense Universitetshospital
Orthopaedic and Radiological Research Unit – Dept. of Orthopaedic Surgery and Traumatology and Dept. of Radiology
Odense University Hospital Institute of Clinical Research – University of Southern Denmark
Introduction
• Fat pad sign - the radiological visualization of the intracapsular but extrasynovial fat pad
• Many studies but still no consensus regarding the % of associated occult fractures
• Most studies don’t distinguish between age and trauma mechanism
• Norell H-G. Roentgenologic visualization of the extracapsular fat. Act Radiol 1954;42:205-10
Orthopaedic and Radiological Research Unit – Dept. of Orthopaedic Surgery and Traumatology and Dept. of Radiology
Odense University Hospital Institute of Clinical Research – University of Southern Denmark
Aim of the study
• A prospective study among children to clarify the relation between the presence of positive fat pad sign (FPS) and the type of injury on MRI
Orthopaedic and Radiological Research Unit – Dept. of Orthopaedic Surgery and Traumatology and Dept. of Radiology
Odense University Hospital Institute of Clinical Research – University of Southern Denmark
Materials and Methods
• Inclusions: – From Marts to Nov. 2010 all children between
6 - 15 years presenting at the emergency room with an elbow trauma and positive FPS without radiological evidence of a fracture
• Exclusion: – Contraindications for MRI – Lack of informed patient consent
Orthopaedic and Radiological Research Unit – Dept. of Orthopaedic Surgery and Traumatology and Dept. of Radiology
Odense University Hospital Institute of Clinical Research – University of Southern Denmark
Materials and Methods Elbow injury
- x-ray
+ x-ray
- FPS
+ FPS - fracture + FPS + fracture no treatment
MRI
Above elbow cast treatment
Clinical control
Orthopaedic and Radiological Research Unit – Dept. of Orthopaedic Surgery and Traumatology and Dept. of Radiology
Odense University Hospital Institute of Clinical Research – University of Southern Denmark
Materials and Methods
• x-ray (AP and lateral): – Positive fat pad and no fracture – Above elbow cast – Sub acute MRI without the cast – Seen 2 weeks after the injury in the outpatient
clinic for clinical examination
Orthopaedic and Radiological Research Unit – Dept. of Orthopaedic Surgery and Traumatology and Dept. of Radiology
Odense University Hospital Institute of Clinical Research – University of Southern Denmark
Results
• 26 patients included • Mean of age: 10 ± 2.6 years • 10 males (38%) and 16 females (62%) • X-ray: performed within 24 h of the trauma • MRI obtained on average of 6.6 ± 4 days • The mechanism of injury: sport and fall during
various daily activities
Orthopaedic and Radiological Research Unit – Dept. of Orthopaedic Surgery and Traumatology and Dept. of Radiology
Odense University Hospital Institute of Clinical Research – University of Southern Denmark
Results
• x-rays – Positive anterior FPS in all – Positive anterior and posterior FPS in 7
• MRI – Positive FPS in all (6 only anterior) – 19 (75%) had bone bruise
• 12 (63%) in olecranon and proximal radius
– 6 (23%) had a fracture
Orthopaedic and Radiological Research Unit – Dept. of Orthopaedic Surgery and Traumatology and Dept. of Radiology
Odense University Hospital Institute of Clinical Research – University of Southern Denmark
Results
Orthopaedic and Radiological Research Unit – Dept. of Orthopaedic Surgery and Traumatology and Dept. of Radiology
Odense University Hospital Institute of Clinical Research – University of Southern Denmark
Results
• 13 patients with soft tissue injury – one with a total m. brachialis rupture
• All patients except 1 had full ROM and no complains after 2 weeks
• The 1 patient with the ruptured brachial muscle had normal ROM after 6 weeks
Orthopaedic and Radiological Research Unit – Dept. of Orthopaedic Surgery and Traumatology and Dept. of Radiology
Odense University Hospital Institute of Clinical Research – University of Southern Denmark
Conclusion
• X-rays continues to be the primary modality for the diagnose of bony injuries in the pediatric elbow
• The presence of positive FPS on x-ray is not synonymous with a fracture in the pediatric elbow