Thursday, March 15, 2012

Children - The Pulled Elbow.

Pulled Elbow – The wailing child with no fracture

With the school holiday on, I though this topic would be appropriate.
The pulled elbow occurs in children following a peculiar type of mechanism to the injury.
It usually involves a tug to the elbow of a child – which usually happens say when the caregiver – parent/nanny is trying to prevent the child from falling or preventing the child from crossing the street.
The child classically holds the elbow straight or slightly bent and particularly resists movement at the affected elbow. This often mimics a fracture at the elbow.
What happens?
The elbow joint consists of 3 bones – the arm bone, the humerus; the two forearm bone, the radius and ulna. The forearm bones are linked at the elbow by the annular ligament and it is the slipping of the head of the radius from this ligament which brings about the condition.
A good history – if classical and clinical evaluation is all that is required for a diagnosis. Often an x-ray is not necessary. I request for an x-ray to rule out a fracture around the elbow if the examination of the child me doubt the diagnosis of a pure pulled elbow – this usually is the case if the elbow is unduly swollen.
Manipulation is done in the clinic-emergency room. If done correctly - with reduction of the radial head, the child is comfortable within minutes and often starts using the limb. It is therefore important to review the child after 15-20 minutes. An arm sling is often used but often unnecessary with the child often discarding it within hours.
Note – Pictures from Netter’s Atlas of Orthopaedics