A 6-year-old boy falls off a swing. Lateral X-ray shows a posterior fat pad sign with no visible fracture line. What is the most likely injury and appropriate management?

• A Olecranon fracture — splint in extension
• B Radial head dislocation — closed reduction
• C Normal variant — reassure and discharge
• D Occult supracondylar fracture — treat as fracture with above-elbow backslab ✓

Explanation

A posterior fat pad sign in a child's elbow after trauma is strongly associated with an occult intra-articular fracture, most commonly a lateral condyle fracture or minimally displaced supracondylar fracture. The posterior fat pad is not normally visible on a lateral X-ray; its appearance indicates haemarthrosis from a fracture. These children should be treated with an above-elbow posterior backslab and re-imaged at 10–14 days when callus may confirm the diagnosis. Discharge without treatment risks missing a significant injury.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.