What's the Diagnosis? By Dr. Sarab Sodhi
A 13 yo F presents to the ED with R elbow pain after falling off the top of a cheerleading pyramid. Exam shows an obvious deformity of the R elbow with swelling and limited ROM. She is neurovascularly intact distal to the injury. An xray is obtained. What's the diagnosis? (scroll down for answer)
Answer: Supracondylar fracture with posterior elbow dislocation
- Elbow dislocations rank 3rd in large joint dislocations and are a commonly seen ED injury
- 90% of all dislocations are posterolateral
- Mechanism of injury is typically fall on an outstretched hand
- Patients present with elbow held in 45 degrees of flexion, with the olecranon being prominent posteriorly
- Neurovascular status must be assessed before and after manipulation!
- Complications include ulnar nerve injury (8-21% patients) and brachial artery injury (5-13% patients)
- Reduction can be done with one of the following methods: traction/flexion, olecranon manipulation or using hanging weights (modification of Stimson technique)
- A long arm posterior splint should be applied post reduction
References: Chow YC. Chow Y.C. Chow, Yvonne C.Elbow and Forearm Injuries. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. Tintinalli J.E., Stapczynski J, Ma O, Yealy D.M., Meckler G.D., Cline D.M. Eds. Judith E. Tintinalli, et al.eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016.