A 14-year-old boy presents to the urgent care with left elbow pain and swelling following a collision and fall during a soccer game. He reports that he ran into another player and braced his fall with his left hand approximately 2 hours prior to presentation. He immediately experienced pain and swelling in the left elbow region. Physical examination reveals noticeable swelling, tenderness, and bruising over the lateral aspect of his left elbow; limited extension and flexion of the elbow; and difficulty with supination and pronation of the forearm. He denies any numbness, tingling, or weakness in the left upper extremity. X-rays are obtained and reveal a fracture line extending through the physis and into the metaphysis of the proximal radius.
What type of fracture is this and what is the best course of treatment?
- Torus fracture; refer to orthopedics.
- Supracondylar fracture; immobilize and refer to orthopedics.
- Salter-Harris type II fracture; immobilize the arm and discharge.
- Monteggia fracture; urgently refer to the ED
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Answer: c. Salter-Harris type II fracture
The patient’s x-rays are consistent with a Salter-Harris type II fracture of the radial neck. Type II fractures are the most common type of physeal fractures, accounting for up to 75% of such injuries. The patient received a dose of ibuprofen (10 mg/kg) in the urgent care for pain control. His left arm was immobilized in a posterior long arm splint, and he was advised to apply ice to reduce swelling when he got home. The patient was discharged home with instructions for continued analgesia, a referral to pediatric orthopedic specialist within 1 week for further evaluation and treatment, and recommendation to avoid weight-bearing activities with the affected arm until cleared by the orthopedist.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
