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HPI

6-year-old otherwise healthy male fell from monkey bars earlier today. He was brought in by his parents to he emergency department due to continued left elbow pain after the fall.

PMH

None

PE

No lacerations or abrasions to the skin. Significant and diffuse swelling about the left elbow. He cries when you attempt to manipulate the elbow. Completely neurovascularly intact distally.

Poll
1 of 10
1. Would you obtain any additional imaging to guide management?
No - current radiographs are sufficient
66%
1122/1680
Yes - additional radiographic views (XR)
14%
249/1680
Yes - CT scan of the elbow (CT)
11%
188/1680
Yes - MRI scan of the elbow (MRI)
2%
43/1680
Yes - CT + XR
1%
33/1680
Yes - MRI + XR
0%
13/1680
Yes - MRI + CT
0%
5/1680
Yes - MRI + CT + XR
0%
3/1680
Outside my area of expertise - best if I don't vote
1%
24/1680
2. Would you use a classification system to guide management?
No - a classification system does not help me
32%
517/1587
Yes - Milch
41%
655/1587
Yes - Jakob
6%
100/1587
Yes - Song
4%
75/1587
Yes - Weiss
5%
87/1587
Yes - Other
1%
20/1587
Outside my area of expertise - best if I don't vote
8%
133/1587
3. How would you manage this injury?
Nonoperative
4%
76/1618
Operative
93%
1512/1618
Outside my area of expertise - best if I don't vote
1%
30/1618
4. If you choose Operative management, would you include an intra-operative arthrogram?
I would not choose Operative management
1%
22/1556
No
71%
1112/1556
Yes
23%
367/1556
Outside my area of expertise - best if I don't vote
3%
55/1556
5. If you choose Operative management, what would be your plan going into surgery?
I would not choose Operative management
0%
6/1564
Attempt Closed reduction percutaneous pinning (CRPP), convert to open only if needed
41%
654/1564
Planned Open reduction percutaneous pinning (ORPP), don't attempt CRPP)
39%
621/1564
Planned Open reduction internal fixation (ORIF)
16%
253/1564
Outside my area of expertise - best if I don't vote
1%
30/1564
6. If you choose Operative management and ended up doing an Open reduction percutaneous pinning (ORPP), what approach would you use?
I would not choose Operative management
0%
3/1513
Anterior
1%
19/1513
Lateral
89%
1352/1513
Medial
1%
25/1513
Posterior
3%
49/1513
Combined
1%
19/1513
Outside my area of expertise - best if I don't vote
3%
46/1513
7. If you choose Operative management and ended up performing a Closed reduction percutaneous pinning (CRPP) or Open reduction percutaneous pinning (ORPP), what pin construct would you use?
I would not choose Operative management
0%
5/1463
Transverse (parallel to the elbow joint) pins only
3%
50/1463
Oblique (up the lateral column) pins only
30%
450/1463
Transverse + oblique pins
63%
924/1463
Outside my area of expertise - best if I don't vote
2%
34/1463
8. If you choose Operative management and achieved the construct shown below, how long would you immobilize the patient postoperatively?
I would not choose Operative management
0%
3/1408
No immobilization
0%
14/1408
<2 weeks
3%
54/1408
2-4 weeks
60%
851/1408
5-6 weeks
31%
446/1408
7-8 weeks
1%
16/1408
>8 weeks
0%
5/1408
Outside my area of expertise - best if I don't vote
1%
19/1408
9. If you choose Operative management and achieved the construct shown below, when would you remove the pins?
I would not choose Operative management
0%
2/1423
at ~ 2 weeks
0%
9/1423
at ~ 3 weeks
15%
214/1423
at ~ 4 weeks
44%
628/1423
at ~ 6 weeks
30%
427/1423
at ~ 8 weeks
5%
78/1423
>8 weeks
3%
46/1423
Outside my area of expertise - best if I don't vote
1%
19/1423
10. If you choose Operative management and achieved the construct shown below, when and how would you begin ROM exercises
I would not choose Operative management
0%
5/1379
No ROM exercise are needed. Motion will come back on its own
24%
341/1379
I would instruct Family to begin ROM Immediately
19%
267/1379
I would prescribe a Physical therapist to begin ROM immediately
8%
123/1379
I would instruct Family to begin ROM starting in several weeks
31%
433/1379
I would prescribe a Physical therapist to begin ROM starting in several weeks
13%
183/1379
Outside my area of expertise - best if I don't vote
1%
27/1379
PROCEDURE #1

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