People often remark to me, 'Wah working in emergency department must be very exciting! I bet you gets to see lots of gory injuries and things people 'accidentally' stick up their various orifices!'

Don't worry, you won't be seeing any of those. :)

What you WILL see, however, are interesting photos, ECGs, Xrays etc. which serve to remind us of the vast variety of cases that may come our way, and some of the learning points behind them.

Enjoy. :)


Tuesday, February 1, 2011

Case 2


25 year old male

Tripped and fell; landed on outstretched right hand
C/o right elbow pain

How would you manage him?

Answer : Occult fracture of right elbow (pathological fat pad sign)

  • Normally in lateral xray of elbow in 90 degrees flexion, the anterior fat pad (lucency a) lies along the anterior surface of the distal humerus, and the posterior fat pad (lucency b) is not seen.
  • When the joint capsule is distended by fluid (commonly blood in the setting of trauma), the anterior fat pad becomes elevated (the sail sign), and the posterior fat pad becomes visible.


  • Most common occult fracture a/w pathological fat pads - head of radius fracture
  • Other causes of fluid around elbow joint - inflammation, infection, neoplasm
  • Need to have high index of suspicion when xray looks seemingly normal but patient has limited or painful range of motion of the elbow
Approach

  • Exclude more serious injuries e.g. head/ neck injuries etc
  • Analgesia as indicated; arm sling
  • Disposition : backslab/ arm sling. Refer to Orthopedics outpatient clinic
Posted by Sentinel at 11:21 PM
Labels: ,

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)