Though many of us encounter a large volume of pediatric patients during residency, that may drastically taper off as we transition to the community. Why is this case important to the emergency physician? He was placed in a sling, encouraged to mobilize the joint early, and discharged with orthopedic follow up in 4 weeks.įigure 1: Lateral view x-ray of the left elbow showing an intra-articular radial head fracture with anterior fat pad (black arrow) and posterior fat pad (white arrow). Following the injection of the local anesthetic, the patient was able to perform active ROM at the elbow so a mechanical block was ruled out. Once the orthopedic consultant was at bedside, we aspirated a small volume of blood from the elbow joint and subsequently injected approximately 5 mL of 1% lidocaine. Orthopedic surgery was consulted because of concern for mechanical block in the setting of an intra-articular radial head fracture. Upon re-evaluation, the patient was still experiencing difficulty with elbow movement despite ibuprofen and ice application. Radiographs revealed an intra-articular radial head fracture (Figures 1 and 2). Additionally, he had limited range of motion (ROM) at the elbow with both elbow flexion and extension as well as with forearm supination and pronation. Upon initial evaluation, he had appreciable swelling and bruising involving the left elbow joint and tenderness to palpation at the lateral surface of the elbow. Just prior to arrival, he had jumped up and fallen directly onto the lateral surface of his left elbow. Authors: Ryan Lynch, MD ( Emergency Medicine Resident, Jackson Memorial Hospital) and Mark Supino, MD (Attending Physician, Department of Emergency Medicine, Jackson Memorial Hospital) // Edited by: Edward Lew, MD Alex Koyfman, MD and Brit Long, MD Case:Ī right hand dominant 15-year-old boy presented with his father for left elbow pain and swelling after injuring himself while playing basketball.
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