The diagnoses are in…

Case A) Nursemaid’s elbow! Azygous was the first to correctly answer, congratulations. I’ll be contacting you by email for a short Mr. Hassle interview to highlight you and your site.

Nursemaids elbow is a common toddler injury and occurs when the head of the radius (forearm bone) slips out of it’s annular (circular) ligament at the elbow. The head of the bone is still smooth and cylindrical and can easily slip in and out until the bones mature a little further which prevents further dislocation. This was a classic presentation, except it usually happens when an adult pulls on the childs arm (swinging in circles, crossing the street) with extra force. In this case, the child did it to himself by pulling really hard on his dad’s hand. Now that’s going to be a stubborn kid! Reduction is easy with gentle manipulation of the elbow in all four extremes of it’s range (pronation, supination, flexion, extension). No ortho consult needed!

Case B) This was a tibial plateau fracture. I alomost missed it, even when I looked at the x-ray. It’s association with lateral meniscus/ACL tears is not surprising, and the exam seemed to support that. I had briefly thought that she had torn her patellar tendon because her tenderness was not only at the joint line, but also down onto the tibia itself. No one guessed this correctly, but several did guess meniscal tear (enoch choi, Doc Russia) , so you all get partial credit. Tibial plateu fractures are fractures on the weight bearing surface of the tibia, so Azygous’ guess of a fracture of the weight bearing portion of the femur also gets partial credit.

These can be surgical or non-surgical cases, but the non-surgical ones need absolute non-weight bearing for 6-8 weeks in addition to physical therapy to prevent atrophy of the quadriceps during this healing time. This one required only a telephone call to the ortho resident on call, and a follow up in 2-3 days in ortho clinic.

The overall winner of this round is Azygous for his correct diagnosis of nursemaid’s elbow and a pretty-close-not-so-unreasonable partial credit for a lateral femoral condyle fracture. Congrats!

If you like these, I’ll do more as I find fun and interesting diagnostic cases…ortho is especially fun since so much information comes from exam alone (unlike heart disease, lung disease, GI which usually require additional testing).

Leave a Reply

Your email address will not be published. Required fields are marked *