Çocuklarda dirsek kırıklarının tespitinde posterior yağ yastığı işaretinin klinik doğruluğu

Abstract

Amaç: Lateral dirsek grafilerinde posterior yağ yastığı bulgusunun (PFPS) akut dirsek travması geçiren pediatrik hastalarda kırık saptamadaki tanısal doğruluğunu değerlendirmek ve PFPS açısının ölçümünün tanısal performansa katkısını incelemektir. Yöntem: Bu retrospektif çalışmaya, Ocak 2022 ile Ocak 2025 tarihleri arasında üçüncü basamak bir acil servise dirsek travması ile başvuran 18 yaş altı hastalar dahil edilmiştir. Tüm hastalara önce lateral dirsek grafisi, ardından altın standart referans yöntem olarak bilgisayarlı tomografi (BT) uygulanmıştır. PFPS varlığı ve posterior yağ yastığı ile humerus şaftı arasındaki açı, BT bulgularına kör iki acil tıp uzmanı tarafından bağımsız şekilde değerlendirilmiştir. Görsel PFPS varlığı ve açı temelli değerlendirme için duyarlılık, özgüllük, olasılık oranları ve yanlış sınıflandırma oranları gibi tanısal ölçütler hesaplanmıştır. Bulgular: Dahil edilen 213 hastanın %65,3’ünde BT ile doğrulanmış dirsek kırığı saptanmıştır. PFPS olguların %66,2’sinde mevcuttu ve kırık öngörüsünde %62,2 duyarlılık ve %81,3 özgüllük göstermiştir. PFPS için optimal açı kesme noktası 16,5° olarak belirlenmiş olup, bu eşik değerde duyarlılık %81,3, özgüllük ise %62,2 bulunmuştur. Sonuç: PFPS, pediatrik dirsek kırıklarının saptanmasında güvenilir bir radyografik göstergedir. Açının nicel olarak ölçülmesi, tanısal doğruluğu artırmakta ve radyografik bulguların belirsiz olduğu acil servis koşullarında daha tutarlı klinik kararlar alınmasına katkı sağlayabilmektedir.

Keywords

• Posterior yağ yastığı bulgusu
• pediatrik dirsek kırığı
• tanısal doğruluk.

Clinical accuracy of the posterior fat pad sign for detecting elbow fractures in children

Abstract

Aims: To assess the diagnostic accuracy of the posterior fat pad sign (PFPS) on lateral elbow radiographs in identifying fractures in pediatric patients with acute elbow trauma, and to evaluate whether angle measurement of PFPS enhances diagnostic performance. Methods: This retrospective study included patients under 18 years who presented with elbow trauma to a tertiary emergency department between January 2022 and January 2025. All patients underwent lateral elbow radiography followed by computed tomography (CT), which served as the reference standard. The presence of PFPS and the angle between the posterior fat pad and humeral shaft were independently assessed by two emergency physicians blinded to CT findings. Diagnostic metrics—including sensitivity, specificity, likelihood ratios, and misclassification rates—were calculated for both visual PFPS presence and anglebased assessment. Results: Of the 213 patients included, 65.3% had CT-confirmed elbow fractures. PFPS was present in 66.2% of cases and demonstrated a sensitivity of 62.2% and specificity of 81.3% for predicting fractures. The optimal PFPS angle cutoff was 16.5°, which yielded a sensitivity of 81.3% and specificity of 62.2%. Conclusion: PFPS is a reliable radiographic indicator of pediatric elbow fractures. Quantitative angle measurement improves diagnostic accuracy and may support more consistent decision-making in emergency settings where radiographic findings are ambiguous.

Keywords

• Posterior fat pad sign
• pediatric elbow fracture
• diagnostic accuracy

Thanks

The authors would like to thank the physicians of the Departments of Emergency Medicine, Radiology, and Orthopedics at Istanbul Yeni Yüzyıl University for their valuable contributions to the clinical evaluation and patient management process during the study period.

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