Reliability of fat-pad sign in radial head/neck fractures of the elbow

Irshad, F.; Shaw, N J; Gregory, Rob

doi:10.1016/s0020-1383(97)00045-4

Cited by 18 publications

(5 citation statements)

References 5 publications

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“…reported that the sensitivity and specificity of the fat pad sign to diagnose radial head/neck fractures were 85.40% and 50%, respectively. The NPV and PPV were 87 and 47, respectively. The anterior humeral line (AHL) is another radiographic parameter used for appraising the severity and post‐reduction achievement of supracondylar fractures in children.…”

Section: Introductionmentioning

confidence: 99%

Intra‐Observer and Inter‐Observer Reliability of Shaft Condylar Angle and Lateral Capitellohumeral Angle: Evaluation Based on Reliability in Different Ages and Levels of Experience

Musikachart

Ariyawatkul

Wongcharoenwatana

et al. 2019

Orthopaedic Surgery

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Objectives The aims of this paper were: (i) to examine the intra‐observer and inter‐observer reliability of the shaft‐condylar angle (SCA) and the lateral capitellohumeral angle (LCHA); (ii) to study the influence of experience level on the inter‐observer and intra‐observer reliability; and (iii) to determine the influence of the the age of the patients on reliability. Method A retrospective cohort study was conducted. The study reviewed 81 elbow radiographs. The patients were aged between 2 and 13 years. All the images taken between 2000 and 2017 were independently measured by a senior pediatric orthopaedic surgeon, a pediatric orthopaedic surgeon, a pediatric orthopaedic fellow, an orthopaedic chief resident, a general practitioner, and a pediatric orthopaedic research assistant. Measurement was performed two times within a 2‐week interval. Inexperienced observers (general practitioner and research assistant) were supervised by senior pediatric orthopaedic surgeons for at least 30 radiographs before performing the measurement. Inclusion criteria were as follows: (i) age 2–13 years; and (ii) no previous elbow fracture. Exclusion criteria: elbow radiographs do not show true lateral view. The intraclass correlation coefficient (ICC) was used to calculate the reliability. Results The mean values of SCA and LCHA were 43° and 48°, respectively. For SCA, intra‐observer reliability was excellent (ICC = 0.85) for one observer, good (range = 0.73–0.76) for three observers, and moderate (0.59) for one observer. Inter‐observer reliability was moderate (0.48, 0.58), whereas the reliability categorized by age group showed excellent agreement (0.88–0.94). For LCHA, intra‐observer reliability was excellent (0.84–0.89) for three observers and good (0.66–0.80) for two observers. Inter‐observer reliability was moderate (0.44–0.45). Conversely, the reliability classified by age group showed excellent agreement (0.83–0.91). Conclusion Intra‐observer reliability for LCHA and SCA were excellent to good for most observers. Inter‐observer reliability was moderate for LCHA and SCA. Reliability classified by age group showed excellent to good agreement. Reliability was influenced by the level of experience, especially for non‐medical staff.

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Section: Introductionmentioning

confidence: 99%

Intra‐Observer and Inter‐Observer Reliability of Shaft Condylar Angle and Lateral Capitellohumeral Angle: Evaluation Based on Reliability in Different Ages and Levels of Experience

Musikachart

Ariyawatkul

Wongcharoenwatana

et al. 2019

Orthopaedic Surgery

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“…12 Although slightly displaced anterior fat pads can be normal, radiographic visualization of the posterior fat pad has > 85% sensitivity for radial head fractures. 15 Therefore, an appropriate history of acute trauma and the presence of a posterior fat pad on radiography merit the presumptive diagnosis of a nondisplaced radial head fracture. 12 Management of radial head fractures is guided by fracture severity, and a simplified treatment paradigm is summarized by the "rule of threes" mnemonic: nonoperative management with early motion when there is (1) < 3 mm articular displacement, (2) less than a third of the articular surface area involved, and (3) < 30 degrees fracture angulation.…”

Section: Common Injury Patterns Radial Head and Neck Fracturesmentioning

confidence: 99%

“…35 Lateral radiographs are mandatory in evaluating this type of fracture (►Fig. 15). Coronal shear fractures 36,37 Type 1 involves a large capitellar osseous fragment, type 2 involves an osteochondral shear injury of the capitellum with only minimal subchondral bone, type 3 involves a comminuted fracture of the capitellum, and type 4 fractures are marked by medial extension of the fracture to involve most of the trochlea (►Fig.…”

Section: Capitellum Fracturesmentioning

confidence: 99%

Radiographic Evaluation of Elbow Fractures

Alidina

Souza

et al. 2021

Semin Musculoskelet Radiol

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Fractures and dislocations of the elbow are a common cause of emergency department visits each year. Radiography remains the bedrock of an initial injury assessment, and recognition of distinctive injury patterns based on fracture location, morphology, and severity, guides optimal clinical decision-making. This article reviews basic elbow anatomy, frequently seen fractures and injury patterns, and highlights how these findings influence surgical planning and patient management.

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“…The negative predictive value (NPV) of this sign is 87% to 98%, and the positive predictive value is 29% to 47%. 31,32 Unfortunately, no specific data on Mason type I fractures were found.…”

Section: Diagnosticsmentioning

confidence: 99%

“…Grade of recommendation: B. 31,32 Level 2: It is likely that up to 65% of patients with a positive fat-pad sign and no evident fracture on conventional radiographs have a radial head fracture. Grade of recommendation: B.…”

Section: Diagnosticsmentioning

confidence: 99%

Mason Type I Fractures of the Radial Head

Keizer¹,

Walenkamp²,

Goslings³

et al. 2015

Orthopedics

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Mason type I fractures are the most common fractures of the radial head. The fractures have a benign character and often result in good, pain-free function. Nevertheless, up to 20% of patients with a Mason type I fracture report loss of extension and residual pain. Currently, there is a lack of consensus concerning diagnosis and treatment of these fractures. The goal of this study was to systematically review incidence, diagnosis, classification, treatment, and outcome of Mason type I radial head fractures in adults and establish an evidence-based treatment guideline. A search of the MEDLINE, EMBASE, and Cochrane databases was conducted for English titles without restrictions on publication date. The authors included titles that addressed Mason type I radial head fractures and covered incidence, diagnostics, treatment, or functional or patient-related outcome. Included were randomized controlled trials; case-control studies; comparative cohort studies; case series with more than 10 patients; and expert opinions. Reference lists were cross-checked for additional titles. The search yielded 1734 studies, of which 95 met the inclusion criteria. Seven studies showed that the elbow extension test has a high sensitivity (88.0-97.6) to rule out Mason type I radial head fractures. If radiography is required, antero-posterior and lateral radiographs suffice. For pain relief, hematoma aspiration seems safe and effective. Mason type I fractures are best treated with 48 hours of rest with a sling, followed with active mobilization. Cast immobilization should be avoided. Mobilization should be encouraged and if needed supported by physical therapy.

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Reliability of fat-pad sign in radial head/neck fractures of the elbow

Cited by 18 publications

References 5 publications

Intra‐Observer and Inter‐Observer Reliability of Shaft Condylar Angle and Lateral Capitellohumeral Angle: Evaluation Based on Reliability in Different Ages and Levels of Experience

Intra‐Observer and Inter‐Observer Reliability of Shaft Condylar Angle and Lateral Capitellohumeral Angle: Evaluation Based on Reliability in Different Ages and Levels of Experience

Radiographic Evaluation of Elbow Fractures

Mason Type I Fractures of the Radial Head

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