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X-Ray Report — Left Elbow AP/Lateral
Patient: MD NUR, 22/M | Date: 14-Apr-26
Study: Left Elbow AP + Lateral | Institution: Jalpaiguri Super Spl Hospital, WB
Radiographic Findings
AP View (left panel):
- The distal humerus appears normal in contour — medial and lateral epicondyles intact, articular surface preserved
- The radial head and neck appear to be in normal alignment relative to the capitellum
- The ulna (particularly the proximal shaft) shows no obvious fracture line on the AP view
- Joint space appears maintained
- No significant soft tissue swelling is appreciable on the film
Lateral View (right panel):
- The elbow is flexed approximately 90°
- The anterior fat pad — looking at the lateral view, there is a suggestion of a positive anterior fat pad sign (elevated/sail sign), which indicates intra-articular effusion
- The posterior fat pad — there appears to be visualization of a posterior fat pad, which is always abnormal and strongly suggests an occult fracture with hemarthrosis
- Radial head alignment with the capitellum (radiocapitellar line) appears maintained
- No gross displacement or obvious cortical break is visible, but the fat pad signs are the key finding
- The olecranon and trochlea appear congruent — no posterior dislocation
Impression / Diagnosis
Most likely diagnosis: Occult radial head fracture (Mason Type I) with intra-articular hemarthrosis
The posterior fat pad sign on the lateral view, combined with an elevated anterior fat pad (sail sign), in a 22-year-old male strongly indicates an intra-articular fracture — most commonly a radial head/neck fracture — even when no fracture line is directly visible. This is a classic radiological presentation sometimes called "No fracture visible, but fracture present" in elbow trauma.
Differentials to consider:
| Diagnosis | Likelihood | Notes |
|---|---|---|
| Radial head fracture (Mason I) | High | Most common in young adults; fat pad signs present |
| Coronoid fracture (small chip) | Moderate | Can be occult; check for fleck sign |
| Lateral condyle fracture | Lower | More common in children; skeletally mature here |
| Elbow dislocation (reduced) | Lower | No incongruity seen |
Recommendations
- Clinical correlation: Tenderness over the lateral elbow / radial head region?
- If fat pad sign confirmed: Treat as radial head fracture — sling immobilization for 2–3 weeks, early range-of-motion exercises
- CT scan of elbow: If surgical planning is needed or if the fracture pattern needs characterization
- Follow-up X-ray in 10–14 days: Periosteal reaction or sclerosis may make the fracture line visible
Important disclaimer: This is an AI-assisted interpretation for educational and informational purposes only. All radiological findings must be confirmed by a qualified radiologist or treating orthopaedic surgeon before clinical decisions are made.
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