Elbow Pain After a Fall

Nursemaid's Elbow or Fracture?

Cohen-Rosenblum, Anna MD
Bielski, Robert J. MD

Anna Cohen-Rosenblum, MD, is a Resident, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center. Robert J. Bielski, MD, is an Associate Professor, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center; and an Attending Pediatric Orthopedic Surgeon, The University of Chicago Medicine Comer Children's Hospital.

Disclosures: The authors have no relevant financial disclosures to disclose.

Address correspondence to Robert J. Bielski, MD, Department of Orthopaedic Surgery and Rehabilitation Medicine, 5841 South Maryland Avenue, MC 3079, Chicago, IL 60637; email: [email protected].

Pediatric Annals 45(6):p e214-e217, June 01, 2016. | DOI: 10.3928/00904481-20160506-01

Nursemaid's elbow and elbow fractures are both common causes of acute elbow pain, but the mechanism of injury is quite different. In children, falls frequently go unwitnessed and children are often inaccurate when recounting the sequences of a fall, making the mechanism difficult to ascertain. A common clinical mistake is to treat all elbow injuries as a nursemaid's elbow. When the mechanism of injury is unknown, radiographs should be used to help make the diagnosis. Occult fractures, also known as “hairline” elbow fractures, may not be visible on initial X-rays, but clues to the diagnosis, especially the posterior fat pad, can be helpful in evaluation. When an occult fracture is suspected based on history and radiographic findings, the patient's elbow should be immobilized, not manipulated. This article also reviews successful reduction maneuvers for nursemaid's elbow. [Pediatr Ann. 2016;45(6):e214–e217.]