2.  CC: Elbow injury
 HPI: 6 yo right-handed male
presents to the ED status post
fall onto outstretched left hand.
Patient states that he was
running on the playground at
school 1 hour ago, when he lost
his balance and fell. He
experienced immediate
throbbing pain and subsequent
swelling in the right elbow. He
denies weakness or sensory
changes. He denies wrist or
hand pain. He denies any other
injuries or LOC.
VS: T: 97.5 P: 120 R: 20 BP:
100/56 O2: 98%RA
Musculoskeletal: RUE: TTP
over lateral condyle of distal
humerus with associated
contusion. No crepitus on
ROM. No gross deformities.
Normal median/radial/ulnar
nerve exam. No TTP over
forearm, wrist, hand. 2+radial.
1+ulnar.

5.  Urgent vs. Emergent Ortho Consult
 Emergent if is displaced
 Posterior splint in 90 degrees
 Ortho Treatment
Non-operative (40%): Non-displaced or minimally
displaced fractures (<2 mm) may be treated with
simple immobilization in posterior sling or with long
arm cast with forearm in neutral position and elbow
flexed to 90 degrees for 3-6 weeks
b. Operative (60%): ORIF is required for moderate
displacement or for complete displacement
a.

6.  Mechanism of injury:
Varus stressing on extended elbow OR axial load such as
FOOSH with force submitted through forearm to
radial head, which impacts lateral condyle
Clinical Evaluation: Mild swelling over lateral humeral
condyle with little to no distortion of the elbow.
Crepitus may be present on ROM.
Imaging: 3 view of elbow is necessary (AP, lateral, and
oblique). Varus views may be ordered to accentuate
any possible displacement

7.  Complications:
 Lateral condylar overgrowth with spur formation
 Delayed union or nonunion
 Angular Deformity
 Neurologic Compromise: ulnar nerve palsy
 Osteonecrosis

9. Koval, K. et al. Handbook of Fractures. 4th Edition. 2010.
Northwestern University School of Medicine: Emergency Medicine
Residency Orthopedic Teaching Files
http://www.feinberg.northwestern.edu/emergencymed/residenc
y/ortho-teaching/
Wheeles Ortho online textbook http://www.wheelessonline.com/
www.rch.org.au