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.]
- 1.Otsuka NY, Kasser JR. Supracondylar fractures of the humerus in children. J Am Acad Orthop Surg. 1997; 5:19–26.
10.5435/00124635-199701000-00003> Crossref MedlineGoogle Scholar
- 2.Barr LV. Paediatric supracondylar humeral fractures: epidemiology, mechanisms and incidence during school holidays. J Child Orthop. 2014; 8:167–170.
10.1007/s11832-014-0577-0> Crossref MedlineGoogle Scholar
- 3.Kraus R, Dongowski N, Szalay G, Schnettler R. Missed elbow fractures misdiagnosed as radial head subluxations. Acta Orthop Belg. 2010; 76:312–315. > MedlineGoogle Scholar
- 4.Diab H, Hamed MM, Allam Y. Obscure pathology of pulled elbow: dynamic high-resolution ultrasound-assisted classification. J Child Orthop. 2010; 4:539–543.
10.1007/s11832-010-0298-y> Crossref MedlineGoogle Scholar
- 5.Eismann E, Cosco E, Wall E. Absence of radiographic abnormalities in nursemaid's elbows. J Pediatr Orthop. 2014; 34:426–431.
10.1097/BPO.0000000000000126> Crossref MedlineGoogle Scholar
- 6.García-Mata S, Hidalgo-Ovejero A. Efficacy of reduction maneuvers for “pulled elbow” in children: a prospective study of 115 cases. J Pediatr Orthop. 2014; 34(4):432–436.
10.1097/BPO.0000000000000130> Crossref MedlineGoogle Scholar
- 7.Krul M, van der Wouden JC, van Suijlekom-Smit LW, Koes BW. Manipulative interventions for reducing pulled elbow in young children. Cochrane Database Syst Rev. 2012;1: CD007759. > MedlineGoogle Scholar
- 8.Skaggs D, Mirzayan R. The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Joint Surg Am. 1999; 81(10):1429–1433. > Crossref MedlineGoogle Scholar
- 9.Skaggs D. Elbow fractures in children: diagnosis and management. J Am Acad Orthop Surg. 1997; 5:303–312.
10.5435/00124635-199711000-00002> Crossref MedlineGoogle Scholar
- 10.Blumberg S, Kunkov S, Crain EF, Goldman HS. The predictive value of a normal radiographic anterior fat pad sign following elbow trauma in children. Pediatr Emerg Care. 2011; 27:596–660.
10.1097/PEC.0b013e318222553b> Crossref MedlineGoogle Scholar
- 11.Shaw J, O'Connor F. Elbow injuries. In: , eds. Pediatric Sports Medicine for Primary Care. Philadelphia, PA: Lippincott Williams & Wilkins; 2002:350–366. > Google Scholar