Çocuklarda dirsek kırıklarının tespitinde posterior yağ yastığı işaretinin klinik doğruluğu

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.