From the Research
For suspected occult elbow fractures with a positive sail sign, immobilize the elbow in a posterior splint or cast for 7-10 days, then obtain a repeat X-ray. The initial immobilization provides pain relief and prevents displacement of any fracture that may be present but not visible on the initial X-ray. After this period, bone resorption at the fracture site often makes previously occult fractures visible on follow-up imaging. If clinical suspicion remains high despite negative follow-up X-rays, consider advanced imaging such as MRI or CT scan for definitive diagnosis. The sail sign (anterior fat pad elevation) is an indirect indicator of joint effusion, which commonly occurs with intra-articular fractures. While not diagnostic on its own, it raises suspicion for occult fractures, particularly supracondylar fractures in children. During the immobilization period, advise patients to keep the arm elevated, apply ice for the first 48 hours, and use appropriate pain medication as needed.
Key Considerations
- The presence of a positive sail sign indicates a potential elbow joint effusion, which may be associated with an occult fracture 1.
- Immobilization for 7-10 days allows for pain relief and prevents displacement of potential fractures, with follow-up X-ray to assess for visible fractures after bone resorption 2.
- Advanced imaging with MRI or CT scan may be necessary if clinical suspicion remains high despite negative follow-up X-rays 3, 4.
- Patient management should prioritize pain relief, immobilization, and monitoring for potential complications, with consideration for advanced imaging or surgical intervention as needed 5.
Management Approach
- Immobilize the elbow in a posterior splint or cast for 7-10 days.
- Obtain a repeat X-ray after the immobilization period to assess for visible fractures.
- Consider advanced imaging with MRI or CT scan if clinical suspicion remains high despite negative follow-up X-rays.
- Advise patients to keep the arm elevated, apply ice for the first 48 hours, and use appropriate pain medication as needed.