Case 50

5 yo male with no significant PMH c/o right elbow pain s/p fall 4 hrs PTA.  Pt was running, slipped, and fell on outstretched hands.  He refuses to move his right arm, holding it in slight flexion and supination. He was sent in by an outside urgent care center for a possible nursemaids's elbow.

Prior to attempts at reduction or X-Ray studies, you get an ultrasound and note the following images.

L elbow - sagittal view

L elbow - sagittal view

R elbow - sagittal view

R elbow - sagittal view

The pt also gets taken for XRs.

lateral XR

lateral XR

QUESTIONS:

  1. What is the “Sail Sign” and why is it useful in assess elbow X rays?
  2. What is a posterior fat pad sign?
  3. What probe is used for evaluation of fractures in the pediatric patient?
  4. What are the ultrasound findings seen above that are abnormal and what do these findings indicate?
  5. Is ultrasound more or less sensitive than XR for elbow fractures?