0:00

<v ->Let's go to the last case of this third block,

0:05

and that's a nice case too.

0:09

So in this last case, this case

0:13

is about a 21-year-old male patient

0:18

with history of trauma while playing soccer five days ago.

0:23

The medical suspicion was a scaphoid fracture.

0:25

You can see here that there is no scaphoid fracture,

0:29

and the problem is in the distal radius.

0:33

You can see a high signal intensity

0:35

in the fluid sensitive sequences.

0:38

In the T1 sequences,

0:39

you can see this low signal intensity here

0:42

and sometime, this areas here, look.

0:45

They look like bubbles

0:48

or drops of fat.

0:50

So this is a sign that is very well described

0:55

in the literature right now that this is a find,

1:00

when you have trauma and you have this find,

1:02

this is a signal of a fracture.

1:06

So here we can see a distal fracture of the radius.

1:11

There is no,

1:14

let's put this image here.

1:16

There is no extension,

1:21

there is no extension to the,

1:23

at least a no big extension to the intra-articular,

1:29

to the bone plate here,

1:30

but we can see that, in this case,

1:34

we have some degree

1:37

of hemarthrosis.

1:40

Look, here to here.

1:41

Let me put you one for you.

1:44

Here's T1.

1:47

In T1, you can see some high signal inside.

1:49

There is a little bit of hemarthrosis here,

1:52

but the main finding that I want to show you

1:55

here in this case is this one.

1:57

There is fat inside the extensor tendons

2:02

of the second and third compartment.

2:05

So here is T1,

2:06

here is T2 with fat saturation.

2:10

In T1, we can see high signal here,

2:13

and with fat saturation, we see low signal similar to fat,

2:18

so this is tenosynovial fat.

2:22

And in the literature,

2:23

they call this also the floating fat sign.

2:29

That's another name that I've heard in the literature

2:34

when talking about this condition right here.

2:38

And one interesting thing

2:41

that I've heard about that

2:45

preparing this case for tonight

2:49

was that the first case

2:52

that showed this fat sign

2:55

inside the tendon sheaths,

2:57

it was in 2010 in a paper from Skeletal Radiology.

3:02

Until 2017, just few papers,

3:06

they were dealing with this alteration,

3:10

and it felt wrong for me because I,

3:13

in my clinical practice, I saw many cases of that,

3:17

but it was like, I could see that just in few case reports.

3:22

But in 2017, one paper,

3:26

I think that

3:27

or that was published in European Radiology,

3:32

they published, they studied a large series

3:37

with CT, with multidetector CT,

3:41

and they have found

3:42

that 71% of patients

3:46

with distal radial fracture,

3:49

they have some degree of fat

3:53

inside the extensor,

3:55

the extensor tendon sheaths,

3:58

especially inside the second

4:01

and third extensor tendon sheath

4:04

like the case that I'm showing for you today.

4:08

So that was, it was okay.

4:09

Now, now I'm happy because my clinical observations

4:15

were different from like, you know, just one report here,

4:19

one report there.

4:20

But this paper, they came

4:23

with 71% of incidents of this find.

4:30

<v ->Well, that's very interesting,

4:31

and I didn't know the frequency was that high.

4:35

The one question, how does the fat get there?

4:39

Does there have to be a defect in the tendon sheath?

4:42

<v ->Yeah, that's a good question.

4:43

And what I've learned is that most of the time,

4:49

the fracture involves this portion, the Lister tubercle,

4:54

and when the fracture

4:56

involves the Lister tubercle, it's rupture,

4:59

the tendon sheath of the third compartment

5:03

or the second compartment,

5:05

and the fat goes through this way.

5:10

<v ->Okay, that makes some sense, but...

5:13

<v ->And that's why the, in the most, the most of the cases,

5:17

the second and the third tendon sheaths,

5:20

they are more, they are compromised.

5:24

<v ->Oh, good.

5:25

Okay, well, terrific cases,

5:27

and I guess we can move on to the final segment.