Approach to common musculoskeletal injuries (pediatrics) Quiz: Ace Your Exams

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A 4-year-old girl presents to the emergency department for evaluation of left elbow pain. A caregiver reports the child was having a temper tantrum at the mall when the caregiver pulled the child by the left arm to go home. The patient immediately began crying and refused to use the left arm. There was no fall or direct trauma to the elbow. The patient is otherwise healthy and takes no daily medication. Vital signs are within normal limits. Physical examination reveals guarding of the left arm, which is held in slight flexion and pronation. There is no evidence of obvious injury or deformity to the left elbow. Capillary refill and sensation are intact. Which of the following is the best next step in management?

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Long arm splint

Direct longitudinal forearm traction

Radiograph of the left elbow

Sling placement with orthopedic follow-up

Extension of the elbow and hyperpronation of the forearm