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. Elbow and Forearm Injuries. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016.