Pulled Elbow: Is X-ray Evaluation Really Required?

Introduction: Pulled elbow is a unique condition affecting paediatric population. The mechanism of injury is well stated by the child's patents. The condition is benign and passes uneventfully following a simple reduction manoeuvre in outpatient department. The condition is detected and treated easily by experts hands but to an unwary clinician may suspect it to be a bony injury and patient may be subjected to x-ray evaluation. The study was conducted to address the need to clinically identifying the condition and treating it without subjecting the patient to x-ray Distribution Users & Roles. Methods: This was prospective study carried out in the department of orthopaedics and trauma surgery Tribhuvan university teaching hospital A total of 20 patients with 21 of total limb were included in the study. Age of the children ranged from 2-6 years of age. The reduction of elbow was done by hyperpronation technique and confirmed by feeling the click at radial head with improvement of symptoms. Result: Among 21 elbows click of reduction was felt in 19. In two elbows no click of reduction was felt and these patients were subjected to x-ray evaluation. The elbow radiographs were normal and patient improved subsequently. Conclusion: A careful history taking with good clinical examination is all that is required for diagnosis and prompt treatment of the condition. An x-ray evaluation is not necessary with proper history is taken and when reduction click is felt and the child shows improvement the child can safely be discharged.