Have you ever been working a shift at 3 am and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This can be a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify common and catastrophic injuries. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. We reviewed the approach to the pediatric elbow previously. Now, the “Can’t Miss” pediatric elbow injuries.
The Pediatric Elbow
- 10% of all pediatric fractures involve the elbow .
- Missed injuries can cause significant deformity, pain, or functional/neurologic complications .
- With many ossification centers, subtle injuries, and significant consequences, the pediatric elbow x-ray can be challenging but important to interpret.
- Non-accidental trauma is, unfortunately, a not uncommon reality. Have a high suspicion for it, especially when there are inconsistencies in the story, mechanism, or the child’s developmental stage. There are certain highly suspicious fracture patterns to be aware of that will be highlighted when appropriate.