The Kager's Fat Pad Sign

  • Kamil Kokulu
    Reprint Address: Kamil Kokulu, md, Department of Emergency Medicine, Ümraniye Training and Research Hospital, Elmalıkent Mahallesi Adem Yavuz Cad. No:1 PK: Ümraniye, İstanbul 34760, Turkey
    Department of Emergency Medicine, Ümraniye Training and Research Hospital, İstanbul, Turkey
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  • Hatice Şeyma Akça
    Department of Emergency Medicine, Ümraniye Training and Research Hospital, İstanbul, Turkey
    Search for articles by this author
      A 44-year-old man presented to the Emergency Department (ED) with severe pain in the right ankle. He stated that he had fallen on his right foot from stairs with three to four steps 1 h before he presented. He had no history of any medical illness nor any medications, and had no previous surgery or injuries to the affected ankle. The physical examination did not reveal any swelling or deformity on the dorsum of the foot or anterior of the ankle. Palpation revealed tenderness and swelling in the retrocalcaneal area. Palpable defect was not detected on examination. The Thompson test was negative. Radiographic imaging was performed to assess the patient's osseous and soft tissues. Lateral radiography of the ankle revealed obscured borders of Kager's fat pad (triangle) and distorted Achilles tendon trace (Figure 1). These findings were consistent with an Achilles tendon rupture, and Orthopedic Surgery was consulted. Surgery was recommended to the patient and the patient was admitted to the hospital. A short leg splint was placed on the patient's leg with the ankle in minimal plantar flexion. The next day the patient was treated surgically. The Achilles tendon was sutured end to end, according to the Kessler method. A below-knee plaster cast was used for 4 weeks. The patient then gradually started weight bearing with a crutch, and 8 weeks after the operation he was able to walk on his own.
      Figure thumbnail gr1
      Figure 1Obscured borders of Kager's fat pad (triangle) (black arrow) and distorted Achilles tendon trace (white arrow) on lateral radiography.
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