Slideshow
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Figure 1. Anteroposterior radiograph of the injured left elbow.
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Figure 2. Lateral view of the elbow.
An 8-year-old girl is brought to the office by her mother with complaints of left elbow pain for 6 days. She injured the elbow from a fall off the monkey bars and is having difficulty moving the elbow since the injury. On physical examination, the patient has mild swelling around the elbow and tenderness to palpation over the olecranon and radial head. Radiographic images taken in the emergency department on the day of the injury (Figures 1 and 2) show fractures in the olecranon and radial neck.
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Pediatric elbow injuries are one of the most common reasons for emergency department or urgent care visits. There are 6 growth centers around the elbow that can make interpreting radiographic findings difficult in pediatric patients. Comparison radiographic images of the uninjured elbow are often necessary to distinguish between normal and abnormal findings.1
Supracondylar fractures are the most common fracture around the elbow (60%), followed by lateral (12%) and medial condylar (12%) fractures, and, less commonly, radial head and olecranon fractures.1 Fractures without displacement are treated nonoperatively with a 3- to 4-week period of immobilization. Options for immobilizing the elbow generally include a long-arm cast, removable long-arm splint, or a sling. The use of a long-arm cast or posterior splint provides improved pain relief over a sling in the first 2 weeks after injury.
Elbow immobilization should not be continued beyond 4 weeks as arthrofibrosis of the elbow can start to set in and could lead to permanent loss of motion. Silva et al found that the use of a removable long-arm soft cast (removable under parent supervision) for nondisplaced elbow fractures provides a convenient option for patients while safely maintaining fracture alignment.2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopaedics for Physician Assistants.
References
1. Lins RE, Simovitch RW, Waters PM. Pediatric elbow trauma. Orthop Clin North Am. 1999;30(1):119-132. doi:10.1016/s0030-5898(05)70066-3
2. Silva M, Sadlik G, Avoian T, Ebramzadeh E. A removable long-arm soft cast to treat nondisplaced pediatric elbow fractures: a randomized, controlled trial. J Pediatr Orthop. 2018;38(4):223-229. doi:10.1097/BPO.0000000000000802
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