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obtained. In many cases, the radiographic studies provide the diagnosis (e.g.,
fracture, dislocation). Normal radiographs in the setting of acute trauma usually
imply soft tissue injury and the patient should be treated symptomatically with
close follow-up, provided that neurovascular integrity is established. If
radiographs appear normal but the child has reproducible tenderness localized to
the epiphyseal plate, then the patient should be presumptively treated for a Salter–
Harris type I fracture. Occasionally, a child with a nursemaid’s elbow may have
an atypical history (e.g., “fell onto arm”); if radiographs exclude a fracture but the
patient is holding the arm in a characteristic position, an attempt at reduction
should be performed.
Children with neurologic abnormalities should be evaluated urgently to
localize the site and cause of the impairment. A thorough neurologic examination,
including examination of reflexes, motor function, and sensation, is imperative.
Based on findings, appropriate imaging and/or consultation with a neurologist or
neurosurgeon should be pursued.