The medial elbow fat pad occupies the olecranon fossa of the distal humerus, visible on lateral X-ray posterior to the humerus. The posterior fat pad is entirely within the olecranon fossa in the normal elbow and is not visible on lateral X-ray unless displaced by effusion.
Visibility of the posterior elbow fat pad on lateral X-ray is always abnormal and indicates significant intra-articular elbow effusion with greater sensitivity than the anterior fat pad sign. A visible posterior fat pad has a positive predictive value of approximately 90% for intra-articular fracture in the acutely injured elbow. It is particularly important in children to identify supracondylar fractures and lateral condyle fractures not apparent on standard views.
Posterior fat pad visibility on lateral elbow X-ray indicating significant intra-articular effusion and approximately 90% probability of occult fracture, prompting additional imaging including MRI in the acutely injured elbow.
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