Radial head dislocation with fat pad sign

Demographic and clinical details: 13-year-old kid   , admitted with fall on an outstretched hand.

Image Details: AP elbow X ray shows the slight separation of proximal radio-ulnar joint (white arrow) with accompanying avulsion fracture of lateral epicondyle (blue arrow). Lateral elbow X-ray shows anterior and posterior fat pad sign (arrows) which should always indicate the intra articular fracture. You can also notice the disturbed the radiocapitellar line which may indicates the radial head fracture or dislocation. Axial CT image shows the fluid leveling due to lipohemarthrosis which always should indicate the presence of intraarticular fracture. Coronal CT image shows the avulsion fractures of lateral ulnar collateral ligament (green arrow) and annular ligament (white arrow head). Sagittal CT image shows the posterior dislocation of radial head (white arrow) with accompanying cortical impaction of capitellum ( black arrow)