Kenneth C. Fortgang is a medical director of Premier Radiology Services. He completed medical school at the Medical College of Georgia and did a surgical internship at the University of Southern California/LAC and a radiology residency and interventional fellowship at USC/LACounty. He also has experience working at level I and II trauma centers at North Broward Hospital District. The document provides guidance on evaluating elbow radiographs for radial head fractures, including identifying the fat pad signs and distinguishing intra-capsular from extra-capsular fractures. Radial head fractures are classified as type I, II, or III depending on the degree of displacement and comminution.

2.  MEDICAL COLLEGE OF GEORGIA; MD
 UNIV OF SOUTHERN CAL/LAC;
SURGICAL INTERNSHIP
 USC/LACOUNTY; RADIOLOGY
RESIDENCY AND INTERVENTIONAL
FELLOWSHIP
 NORTH BROWARD HOSPITAL DISTRICT;
LEVEL I AND LEVEL II TRAUMA CENTERS

3. Kenneth C. Fortgang, MD
Medical Director
Premier Radiology Services

7. Anatomy H
U
M
E
R
U
S
TROC CAP
U R
L A
N D
A I
U
S
©Ken L Schreibman, PhD/MD 2003

8. Anatomy H
U
OLECRANON M
E
R
U
S
TROCCAP
R
U A
L D
N I
A U
S
CORONOID
©Ken L Schreibman, PhD/MD 2003

9. H
Posterior Fad Pad Anterior Fad Pad
(Olecranon Fossa)
U (Coronoid Fossa)
M
E
R
U
S
CAP
©Ken L Schreibman, PhD/MD 2003

13.  Adequate Exposure
 Alignment
 Bone Contour
 Margins
 Density
 Tabecular pattern
 Soft tissues

14.  Ask for 3 views: AP, oblique extended, lateral
90 degree flexion.
 Look for sail sign and posterior fat pad
 If these signs are present but no fracture is
identified, radial head fracture is likely.
 Look for a fracture line and contour deformity

16. Radial head fracture types
•Type I: less than 2 mm displacement
•Type II: angulated or >2 mm displaced
•Type III: comminuted

19. Figure 1. Lateral radiograph shows a positive fat pad sign in a patient with a nondisplaced
fracture of the radial head.
Goswami G K Radiology 2002;222:419-420
©2002 by Radiological Society of North America

20.  Radial neck fracture  Extra-capsular
 No FAT PAD

29.  Look for fat pads signs (capsular effusion)
 Anterior fat pad (from coronoid fossa) may be
normal; compare to other side
 Posterior fat pad (from olecranon fossa) is always
abnormal
 Compare to x-rays of other side in children
 If elbow can’t be extended, obtain AP/lat of both
humerus and forearm