Fractures and dislocations: elbow fat pad sign: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Orthopaedics · Fractures and dislocations: elbow fat pad sign

Sample item

A 5-year-old falls on an outstretched hand and has a swollen, tender elbow. The lateral radiograph shows no visible fracture line, but there is an elevated anterior fat pad and a visible posterior fat pad. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Above-elbow back slab and review, treating as an occult fracture

A raised anterior fat pad with a visible posterior fat pad means a joint effusion, which after trauma is usually blood from an intra-articular fracture. In a child the commonest hidden injury is a supracondylar or radial neck fracture, so the elbow is immobilised and re-assessed with repeat films.

Option by option

  • A. Discharge with a sling, since the film is normal

    A normal-looking bone outline does not exclude fracture when a posterior fat pad is visible.

  • B. Immediate surgical exploration of the elbow

    Surgery is for displaced fractures and not for a suspected undisplaced injury.

  • C. Above-elbow back slab and review, treating as an occult fracture (correct)

    Correct. The posterior fat pad indicates haemarthrosis from an occult fracture, so immobilise and review.

  • D. Aspiration of the joint for culture

    Aspiration is for suspected infection and the history here is acute trauma without fever.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Orthopaedics questions

Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Above-elbow back slab and review, treating as an occult fracture. A raised anterior fat pad with a visible posterior fat pad means a joint effusion, which after trauma is usually blood from an intra-articular fracture.

Why is "Discharge with a sling, since the film is normal" not the answer?

A normal-looking bone outline does not exclude fracture when a posterior fat pad is visible.

Why is "Immediate surgical exploration of the elbow" not the answer?

Surgery is for displaced fractures and not for a suspected undisplaced injury.

Why is "Aspiration of the joint for culture" not the answer?

Aspiration is for suspected infection and the history here is acute trauma without fever.

What concept does this question test?

It tests Fractures and dislocations: elbow fat pad sign in Orthopaedics. In a child the commonest hidden injury is a supracondylar or radial neck fracture, so the elbow is immobilised and re-assessed with repeat films.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fractures and dislocations: elbow fat pad sign?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.