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Sound and Fury
Picture of Dallas239
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Last night my daughter fell of a bunk-bed ladder and landed on her elbow and side. It was still bothering her tonight, so my wife took her to pediatric urgent care and they x-rayed it. The physician thought she saw a fracture. The radiologist said no fracture, but follow-up might be warranted. I think I understand his notes, but what I don't understand is, should we follow up with the pediatric orthopedist in 5-7 days no matter what (unfortunately, we're well acquainted with a good one), or only if it is still bothering her? Basically, I don't know what, "If there is clinical concern for growth plate injury" means. The urgent care physician did suggest follow-up, but the radiologist notes seem more equivocal. TIA.





"I've spoken of the shining city all my political life, but I don't know if I ever quite communicated what I saw when I said it. But in my mind it was a tall proud city built on rocks stronger than oceans, wind-swept, God-blessed, and teeming with people of all kinds living in harmony and peace, a city with free ports that hummed with commerce and creativity, and if there had to be city walls, the walls had doors and the doors were open to anyone with the will and the heart to get here." -- Ronald Reagan, Farewell Address, Jan. 11, 1989

Si vis pacem para bellum
There are none so blind as those who refuse to see.
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Posts: 18039 | Registered: February 22, 2002Reply With QuoteReport This Post
Funny Man
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Go have your pediatric ortho look at it and advise treatment. I wouldn't wait the 5 to 7 days, just go when you can get an appt.


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Posts: 7093 | Location: Austin, TX | Registered: June 29, 2010Reply With QuoteReport This Post
Oriental Redneck
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That's typical of radiology reports, many times wishy washy, because they do not want to commit reading it definitively one way or the other. So, just to cover their ass, it's always "recommend follow up" with another study, if "clinically indicated".

They should have given you a CD copy of the Xrays. Take it along with your daughter for F/U with a pedi ortho is what I would do. Let the pedi ortho look at it.


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Posts: 26203 | Location: TEXAS | Registered: September 04, 2008Reply With QuoteReport This Post
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Not a doctor.

BUT, I wouldn't screw around. I'd go straight to the orthopedic Ortho ASAP, not in 5-7 days.
 
Posts: 21335 | Registered: June 12, 2005Reply With QuoteReport This Post
Funny Man
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quote:
Originally posted by 12131:
That's typical of radiology reports, many times wishy washy, because they do not want to commit reading it definitively one way or the other. So, just to cover their ass, it's always "recommend follow up" with another study, if "clinically indicated".

They should have given you a CD copy of the Xrays. Take it along with your daughter for F/U with a pedi ortho is what I would do. Let the pedi ortho look at it.


I wouldn't waste your time getting copies of the images. No way an ortho will accept the images obtained in an urgent care. They will want their specific view/angles/exposures etc....and not to mention they will want to bill for those as well.


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Posts: 7093 | Location: Austin, TX | Registered: June 29, 2010Reply With QuoteReport This Post
Oriental Redneck
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Dallas, everyone is different, and the following, although not hard and fast rule, can be very helpful in determining whether you have an elbow fracture.

If she can completely straighten out her elbow, and be able to pronate and supinate it freely without any real discomfort, it's unlikely to be fractured. Even so, still go to the pedi ortho, I would.


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Posts: 26203 | Location: TEXAS | Registered: September 04, 2008Reply With QuoteReport This Post
Sound and Fury
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She cannot straighten it beyond about 10 degrees of straight, and she says that supination is painful when it comes to moving her elbow.

My wife was planning to drop of the CD at the ortho tomorrow, but they are scheduling out about a week due to the holiday. I understood the recommendation to follow up on a week was because a healing fracture shows up better on film, but I don't want to wait if it's going to cause issues.




"I've spoken of the shining city all my political life, but I don't know if I ever quite communicated what I saw when I said it. But in my mind it was a tall proud city built on rocks stronger than oceans, wind-swept, God-blessed, and teeming with people of all kinds living in harmony and peace, a city with free ports that hummed with commerce and creativity, and if there had to be city walls, the walls had doors and the doors were open to anyone with the will and the heart to get here." -- Ronald Reagan, Farewell Address, Jan. 11, 1989

Si vis pacem para bellum
There are none so blind as those who refuse to see.
Feeding Trolls Since 1995
 
Posts: 18039 | Registered: February 22, 2002Reply With QuoteReport This Post
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quote:
Originally posted by Dallas239:
She cannot straighten it beyond about 10 degrees of straight, and she says that supination is painful when it comes to moving her elbow.

My wife was planning to drop of the CD at the ortho tomorrow, but they are scheduling out about a week due to the holiday. I understood the recommendation to follow up on a week was because a healing fracture shows up better on film, but I don't want to wait if it's going to cause issues.


Have your daughter go there with your wife to drop off the CD. Sometimes If she just happens to be there.....and the ortho just happens to be available...he might look at the CD right then and there and do something or a splint or something.
 
Posts: 21335 | Registered: June 12, 2005Reply With QuoteReport This Post
Oriental Redneck
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quote:
Originally posted by Dallas239:
She cannot straighten it beyond about 10 degrees of straight, and she says that supination is painful when it comes to moving her elbow.

My wife was planning to drop of the CD at the ortho tomorrow, but they are scheduling out about a week due to the holiday. I understood the recommendation to follow up on a week was because a healing fracture shows up better on film, but I don't want to wait if it's going to cause issues.

Well, that's a concern. Did they at least put her on an elbow splint from the urgent care? They should have. Obviously, this is not an orthopedic emergency requiring immediate reset or surgical intervention, so being seen a few days after is not out of the question.


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Posts: 26203 | Location: TEXAS | Registered: September 04, 2008Reply With QuoteReport This Post
Sound and Fury
Picture of Dallas239
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quote:
Originally posted by 12131:
quote:
Originally posted by Dallas239:
She cannot straighten it beyond about 10 degrees of straight, and she says that supination is painful when it comes to moving her elbow.

My wife was planning to drop of the CD at the ortho tomorrow, but they are scheduling out about a week due to the holiday. I understood the recommendation to follow up on a week was because a healing fracture shows up better on film, but I don't want to wait if it's going to cause issues.

Well, that's a concern. Did they at least put her on an elbow splint from the urgent care? They should have. Obviously, this is not an orthopedic emergency requiring immediate reset or surgical intervention, so being seen a few days after is not out of the question.
No splint. Ace bandage and sling.




"I've spoken of the shining city all my political life, but I don't know if I ever quite communicated what I saw when I said it. But in my mind it was a tall proud city built on rocks stronger than oceans, wind-swept, God-blessed, and teeming with people of all kinds living in harmony and peace, a city with free ports that hummed with commerce and creativity, and if there had to be city walls, the walls had doors and the doors were open to anyone with the will and the heart to get here." -- Ronald Reagan, Farewell Address, Jan. 11, 1989

Si vis pacem para bellum
There are none so blind as those who refuse to see.
Feeding Trolls Since 1995
 
Posts: 18039 | Registered: February 22, 2002Reply With QuoteReport This Post
Oriental Redneck
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Regarding pedi bone growth plate injuries, there is a classification for the type of injuries developed by Dr Salter (orthopedist) and Dr Harris (radiologist), known as the Salter-Harris fractures. They range from Type I (least serious) to Type V (most serious). The following cartoon from the internet illustrates them pretty well.



You can see why Type V is the most serious, as the the growth plate is completely crushed.
Type I is least serious, because everything is still there intact, with only separation +/- displacement. Treatment is simple casting. Complications are rare in type I injury.


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Posts: 26203 | Location: TEXAS | Registered: September 04, 2008Reply With QuoteReport This Post
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Even with good x-rays, you can't always see fractures.

I hurt my shoulder a couple of years ago - it seemed like a partial rotator cuff tear. I went to a good orthopedic doctor and they did a BUNCH of x-rays on a fancy digital x-ray machine. No damage was visible but he thought one of the tubercles (the ridges on the bone that the rotator cuff tendons attach to) looked like it wasn't in quite the right spot. He ordered an MRI and sure enough, the tubercle was fractured, had damn near broken off completely, and was several millimeters from where it was supposed to be. (It turns out this was better than a rotator cuff tear, at least long term - I had to wear a sling and not raise my arm for two months, but I didn't need surgery and was back to 100% after the bone healed.)
 
Posts: 6319 | Location: CA | Registered: January 24, 2011Reply With QuoteReport This Post
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12131 beat me to the explanation of Salter fractures. In the ED, if the injury/pain is significant enough, I always splint as if a Salter I injury is present. I'll show the parents the "invisible" growth plates on the xray, so they understand why I'm being extra cautious. Definitely follow up with ortho. Repeat xrays will often show signs of a healing fracture when the initial films were negative.
 
Posts: 214 | Registered: December 29, 2016Reply With QuoteReport This Post
Sound and Fury
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Thanks all. Follow up with orthopedist is Monday. We can definitely keep it wrapped and in sling until then. Should I get/make a splint to keep it immobile?




"I've spoken of the shining city all my political life, but I don't know if I ever quite communicated what I saw when I said it. But in my mind it was a tall proud city built on rocks stronger than oceans, wind-swept, God-blessed, and teeming with people of all kinds living in harmony and peace, a city with free ports that hummed with commerce and creativity, and if there had to be city walls, the walls had doors and the doors were open to anyone with the will and the heart to get here." -- Ronald Reagan, Farewell Address, Jan. 11, 1989

Si vis pacem para bellum
There are none so blind as those who refuse to see.
Feeding Trolls Since 1995
 
Posts: 18039 | Registered: February 22, 2002Reply With QuoteReport This Post
Equal Opportunity Mocker
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Not an MD here, but I have some working understanding of ortho. Also, my daughter slipped and fell at a local eatery a year ago, and had a left elbow pain with no dislocation on hers either. Sounds like exactly the same scenario. Hers was a non displaced fracture, which the pediatric ortho ended up hard casting for a couple weeks and then an arm splint for a few more. She's fine now, but those Salter fractures are a concern in a younger kiddo.


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Posts: 6389 | Location: Mogadishu on the Mississippi | Registered: February 26, 2009Reply With QuoteReport This Post
Sound and Fury
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So she went to the ortho today. New xrays and still nothing definitive. She still has swelling, and apparently the pain is right on the growth plate, so she's now in an above-the-elbow hard splint with recheck in a week.




"I've spoken of the shining city all my political life, but I don't know if I ever quite communicated what I saw when I said it. But in my mind it was a tall proud city built on rocks stronger than oceans, wind-swept, God-blessed, and teeming with people of all kinds living in harmony and peace, a city with free ports that hummed with commerce and creativity, and if there had to be city walls, the walls had doors and the doors were open to anyone with the will and the heart to get here." -- Ronald Reagan, Farewell Address, Jan. 11, 1989

Si vis pacem para bellum
There are none so blind as those who refuse to see.
Feeding Trolls Since 1995
 
Posts: 18039 | Registered: February 22, 2002Reply With QuoteReport This Post
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quote:
Originally posted by Dallas239:
So she went to the ortho today. New xrays and still nothing definitive. She still has swelling, and apparently the pain is right on the growth plate, so she's now in an above-the-elbow hard splint with recheck in a week.


Hope it turns out fine.

Kid injuries are tough. They are not just 'small adults' and need to see specialists as you did.

Best wishes-

---------------------------------


Proverbs 27:17 - As iron sharpens iron, so one man sharpens another.
 
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