An Elbow Injury and a Lesson in Supracondylar Fractures

​BY GREGORY TAYLOR, DO, & JACKLYN MCPARLANE, DOAn 87-year-old woman presented with left elbow pain after a fall. She was walking down the stairs when she tripped where the hardwood stairs met the carpet, and she felt her elbow twist as she hung onto the rail.Her vitals were stable and within normal limits, but she had diffuse swelling, ecchymosis, and tenderness around the left elbow joint. There were no open wounds, abrasions, or skin breakdown, but her left elbow was grossly unstable. Motor and sensory skills were distally intact to the anterior interosseous, posterior interosseous, median, ulnar, and radial nerves. Two-point discrimination was intact to 5 mm in all digits. She had no pain with passive extension of the digits, and flexion and extension were intact.All compartments were soft and compressible with 2+ radial pulses. Radiography of the left elbow demonstrated a comminuted and displaced supracondylar T-type fracture of the distal left humerus. (Images A and B.) The patient underwent immediate closed reduction of the left distal humerus with her neurovascular exam remaining unchanged.Radiography of the left elbow demonstrated a comminuted and displaced supracondylar T-type fracture of the distal left humerus.She was taken to the operating room the next day for open reduction and internal fixation of the left humerus. (Images C and D.) Her post-operative course was complicated, consisting of multiple ED visits and admissions. She has had five surgical revisi...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research