Elbow injuries

Supracondylar fracture
Undisplaced - Collar & cuff. Refer VFC
Displaced - If neurovascular injury ask advice urgently. Refer Ortho On-call.

Dislocation of elbow                                     
If neurovascular injury, ask advice urgently.
Reduce (sedation in adults - GA in children)
Post reduction X-ray. Re-check neurovascular status. Wool & crepe, sling.
If associated with fracture or joint unstable post reduction refer Ortho On-call.

T or Y intercondylar fractures 
Refer Ortho On-call

Fractures condyle/epicondyle
Undisplaced - Backslab. Refer to Fracture Clinic
Displaced - Refer orthopaedics

Pulled elbow                                                 
This is a clinical diagnosis. No x-rays necessary in patient with a typical history and examination.
Manipulate - it should go back with a 'click'. Wait 5-10 minutes.
If the child starts to use elbow - discharge - no follow-up.
If the child does not start to use elbow reconsider diagnosis (x-ray if necessary), collar and cuff, Review Clinic next day if still not using.

Fracture radial head   
Undisplaced - Collar & Cuff. Refer VFC. Beware associated injuries
Widely displaced  - Refer Ortho On-call.

Fracture radial neck
Undisplaced - Collar & Cuff. Refer VFC.
Widely displaced - Refer Ortho On-call.

Fracture olecranon
Undisplaced - Wool & crepe. Collar & Cuff. Refer VFC.
Displaced - Refer Ortho On-call.

Dislocation radial head    
May be of long standing - ask advice

Elbow injury with radiological evidence of an effusion but no fracture.    
Collar and Cuff. (positive fat pad sign) Review Clinic in one week

NB Elbow injuries are treated in a collar and cuff not a broad arm sling.