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Figure 1. Anterior-to-posterior radiographic view indicating a nondisplaced longitudinal
radial head fracture. The arrows mark the ends of the fracture lines, which extend through the
articular surface of the radial head.
Copyright 2010 Journal of Orthopaedic & Sports Physical Therapy. All rights reserved.
Figure 2. Lateral radiographic view demonstrating a positive fat pad sign. The lucencies
(darker areas due to decreased radiodensity) anterior (orange arrow) and posterior (white
arrows) to the distal humerus indicate displacement of the anterior and posterior fat pads
due to joint effusion.

Radial Head Fracture Following a Fall

James A. Dauber, DPT, DSc, OCS, SCS, Physical/Occupational Therapy Flight Commander, 96th Medical Group, Eglin AFB, FL.
Scott R. Naspinsky, MD, Radiologist, Penn State Milton S. Hershey Medical Center, Hershey, PA.

A
26-year-old man who was eral views). The anterior-to-posterior ing activities. At 6 weeks following the
serving in the military was referred radiographic view revealed a nondis- injury, he successfully returned to full
Journal of Orthopaedic & Sports Physical Therapy

to a physical therapist for an acute
right elbow sprain following a fall on an
outstretched hand 36 hours prior. The
patient reported immediate pain and
restricted elbow motion following the
injury.
Physical examination revealed lim-
ited active and passive elbow flexion
and extension range of motion because
of pain. Sharp tenderness to palpa-
tion was noted directly over the radial
head, and elbow effusion was present.
Because the history and physical ex-
amination findings were concerning
for a possible radial head fracture, 1 the
physical therapist ordered elbow radio-
graphs (anterior-to-posterior and lat-
placed longitudinal radial head frac-
ture involving the lateral one third of
the radial head (FIGURE 1). The lateral
radiographic view revealed lucencies
anterior and posterior to the distal hu-
merus, indicating displacement of the
anterior and posterior fat pads (fat pad
sign) due to joint effusion ( FIGURE 2).
The patient was referred to an
orthopaedic physician for fracture man-
agement. Initial treatment included
relative rest, use of an elbow sling, and
pain-free active range-of-motion exer-
cises. At 3 weeks following the injury,
the patient began performing a pain-free
push-up progression in preparation for
full return to military physical train-
unrestricted activity, with no residual
deficits.
Patients presenting with history and
physical examination findings that are
concerning for a fracture require ap-
propriate diagnostic imaging before ini-
tiation of treatment. More specifically,
patients who cannot fully extend their
elbow after a traumatic injury should be
referred for radiography.1 Clinicians
should be vigilant for the fat pad sign on
elbow radiographs in patients following
trauma, especially in an otherwise negative
radiographic study, as this indicates joint
effusion and possibly an occult fracture.2
t J Orthop Sports Phys Ther 2010;40(1):30.
doi:10.2519/jospt.2010.0401

References
1. Appelboam A, Reuben AD, Benger JR, et al. Elbow extension test to rule out elbow fracture: multicentre, prospective validation and observational study of diagnostic accuracy
in adults and children. BMJ. 2008;337:a2428. http://dx.doi.org/10.1136/bmj.a2428
2. Goswami GK. The fat pad sign. Radiology. 2002;222:419-420.

The opinions expressed on this document are solely those of the authors and do not represent an endorsement by, or the views of, the United States Air Force, the Department
of Defense, or the United States Government.

30 | january 2010 | volume 40 | number 1 | journal of orthopaedic & sports physical therapy

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