The anterior elbow fat pad space lies within the coronoid and radial fossae of the distal humerus, filled by the anterior fat pad. The fat pad acts as a synovial fluid buffer and cushion during full flexion. On lateral X-ray it appears as a small, low-density triangle anterior to the distal humerus.
The anterior fat pad space is displaced superiorly and anteriorly when intra-articular elbow effusion accumulates, producing the sail sign on lateral elbow X-ray. Elbow effusion causes the fat pad to be lifted out of the coronoid and radial fossae, making it visible as an elevated lucent structure. This is a key radiographic sign for occult radial head fracture in adults and lateral condyle fracture in children.
Elevation of the anterior elbow fat pad from its normal position in the coronoid and radial fossae by intra-articular haemarthrosis or effusion, indicating significant intra-articular pathology requiring further imaging.
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