What's the Diagnosis? By Dr. Michael Tom
Wed, 03/13/2019 - 1:00pm
Editor:
A 19 yo M presents to the ED complaining of elbow pain after running into a wall with an outstretched arm. His elbow is swollen, tender and ROM testing elicits pain. An xray is obtained. What's the diagnosis? (scroll down for answer)
Diagnosis: Radial Head Fracture
- Can be subtle on plain films
- On xray above:
- large anterior fat pad (sail sign); small anterior fat pad can be physiologic
- posterior fat pad (always pathologic, suggests fracture)
- malalignment of the radiocapitellar line
- Of note: in adults, these fat pads are suggestive of radial head fracture while in pediatrics, they suggest supracondylar fracture
- Radial head fracture is the most commonly seen elbow fracture
- Exam often reveals pain to palpation of the lateral elbow, pain worse w/ supination and pronation
- Common mechanism is FOOSH
- If no or minimal displacement, can be treated conservatively with immobilization and orthopedic follow up
- When associated with concurrent disruption of the interosseous membrane of distal radio-ulnar joint= Essex Lopresti Fracture