Clinical Challenge 2: June, 2015

The Resolution

Diagnosis: Occult elbow fracture.
Note the posterior fat pad that is evident on this lateral view (Figure 2). Posterior fat pads are never normal and usually represent an occult elbow fracture when no other radiographic findings are seen.

Note the sail sign (arrows), which identifies the anterior fat pad. This may be normal when present without other radiographic abnormalities. (Figure 1 modified with permission and Figure 2 used unmodified with permission under a Creative Commons BY 3.0 U.S. license from James Heilman, MD. Fat pad sign. In: Wikipedia. http://en.wikipedia.org/wiki/Fat_pad_sign. Original figure available from http://commons.m.wikimedia. org/wiki/File:Sailsign.PNG.)