QUESTIONS:

  • What common locations for occult fractures?

 

  • What are the most common locations for fat-pad signs?

 

  • What testing can be used for possible occult fractures?

 

 

ANSWERS:

  • Occult fractures commonly occur in the following locations: scaphoid, hip, metatarsal stress fracture, radial head (adults), supracondylar elbow (kids)

  • The most common locations for fat-pad signs: Elbow >>ankle, distal radius.  Sometimes you just see an effusion rather than a fat pad, as in the ankle x-ray below

  • Testing for occult fractures:  MRI or bone scans are more sensitive, but are rarely needed acutely, repeat films in 7-10 days my show previously occult fractures as osteoclasts have “cleaned” the fracture edges.