A 5 year old female presents to my clinic with a chief complaint of elbow pain and swelling. The young patient’s parents report her mechanism of injury; witnessed her falling on a bent elbow. She presents with moderate swelling, eechymosis, and refusing to move her elbow thru full range of motion.

The clinical question of the week:

How do you treat this patient? Do you reduce fracture/dislocation or reduce nurse maids elbow?

Answer:

Treat Supracondylar Fracture and reduce dislocated radius.

Based on the patients age it would be highly unlikely for this to be a nurse maids elbow. The Mechanism of Injury does not match that of a nurse maids elbow. The MOI for a nurse maids elbow in kids is when the forearm is pulled, the radial head moves distally and the ligament slips over the radial head and becomes trapped within the joint.

The child, in this case, fell on a bent elbow. The x-ray clearly shows a dislocated radial head and a non-displaced supracondylar fracture.

Also note the anterior fat pad on initial x-ray. An elevated anterior lucency or a visible posterior lucency on a true lateral x-ray of an elbow flexed at 90’ is described as a POSITIVE fat pad sign.

Question provided by Skin, Bones, Hearts & Private Parts speaker Mary Vacala, PA-C, ATC MSPAS, DFAAPA.