Elbow fracture and dislocation management in children
Paediatric elbow injuries are common in emergency departments and a frequent exam topic. Priorities in the ED are a systematic assessment of the whole upper limb, early analgesia, careful neurovascular documentation, safe immobilisation and timely escalation to orthopaedics when indicated.
Follow local orthopaedic and radiology pathways; national guidance on general fracture management and imaging workflows is summarised in NICE NG38 and RCEMLearning (NICE NG38; RCEMLearning; HTG739).
Key principles
- Assess the entire ipsilateral upper limb (clavicle to hand), not just the elbow.
- Give age‑appropriate analgesia early and reassess the response (use local formulary for doses).
- Perform and document a focused neurovascular examination (motor, sensory, distal pulses, capillary refill) before and after any intervention.
- Immobilise in a comfortable position for pain control and safe transfer; do not manipulate displaced fractures in ED unless explicitly authorised by orthopaedics and clinician competence is assured.
- Keep the child nil by mouth (NBM) if operative management is a possibility.
- Ensure appropriate radiographs are obtained and reviewed (hot reporting where available) and arrange follow‑up per local fracture clinic pathways (virtual clinics acceptable for many minor injuries) (NICE NG38; HTG739).
Clinical assessment
History
- Document mechanism of injury (FOOSH, direct blow, avulsion), time since injury, presence of immediate deformity, any prior manipulations, hand dominance, and relevant past medical history (bleeding disorders, neuromuscular...