4.4 of 26 Ratings
A 7-year-old nonverbal boy with severe Autism is brought to the emergency department by his caretaker after noticing a bump over the left elbow. She states that the patient falls often but is not sure when the bump first appeared. The patient moves his bilateral upper extremities spontaneously and without apparent discomfort. Examination of his left elbow is notable for a prominence over the posterolateral elbow that is nontender. Plain radiographs are pictured in Figures A and B. What is the next best step in management?
Plain radiographs of the contralateral elbow
Closed reduction under sedation
Open reduction with annular ligament reconstruction
Open reduction with ulna osteotomy
Radial head resection
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A 17-year-old boy presents with pain in his right elbow for 2 years and limitation in elbow motion bilaterally. He denies any pain or discomfort in his left elbow. He reports no history of trauma to either elbow. He has had two courses of physical therapy, but has noted no noticeable improvement in pain or motion. Examination demonstrates no elbow tenderness on palpation, and there are no neurological deficits. Manual reduction is unsuccessful. The range of motion of both elbows is shown in Figure A. Radiographs of left and right elbow are shown in Figure B and C respectively. What is the most appropriate treatment plan for the right and left elbow?
Bilateral open reduction and application of a hinged external fixator to both elbows
Radial head resection of the right elbow and non-operative management of the left elbow.
Bilateral radial head arthroplasty
Physical therapy and splinting to both elbows
Radial head resection and interposition arthroplasty for the right elbow and radial head resection alone for the left elbow