Orthorama #1 - Answers

27 y.o. male snowboarder fell back on his extended left arm.  He felt immediate pain in his left elbow.  He is not able to actively move his elbow in your exam. 

Here is what you see:

What other exam information do you want to obtain?

Neurovascular exam - which revealed an absence of radial pulses.  Capillary refill was 2-3 seconds.  Patient complained of parathesias in his hand.

What are the two most likely diagnosis?

1.  Elbow dislocation

2.  Supracondylar fracture

The assessment was he likely had a dislocation.  Traction was applied to the forearm to relocate the humerus after the patient was given 2 mg of Dilaudid, however, there was also crepitus felt and heard above the condyles when this was attempted.  We were not able to successfully reduce the fracture or the dislocation.

What are the next immediate steps in your care of this patient, since transport to the nearest hospital is 90 minutes away? 

Traction splint was created to improve the circulation to the hand and he was immediately transported to the Emergency Dept. in the nearest hospital.

What tool would you use to remove his piercing in case he requires an MRI?

Your handy Leatherman, which you always carry while on ski patrol.

Why is this patient perspiring so?

Wouldn't you if you knew someone was about to put some major traction on your arm that looked like this?

Back to the Orthorama Page