Case: A 33-year-old man presented with a closed distal humerus fracture after a fall from scaffolding. Computed tomography demonstrated intra-articular gas, despite the lack of arthrotomy, open fracture, or skin defects. The "vacuum phenomenon" (VP), or the presence of intra-articular gas in closed injuries, has primarily been described in the axial skeleton. To our knowledge, there are no reports in fractures of the elbow.
Conclusion: The incidence of the VP is under-reported and represents a lack of physician awareness. The VP should remain a diagnosis of exclusion; however, physicians should be aware of this phenomenon to prevent unnecessary patient harm.