Dr. Richard McCollum: The patient is an 8-year-8-month-old girl who fell off of her bed injuring her left arm. She was able to sleep through the night, but by morning considerable pain and swelling was noted and a physician was consulted. Roentgenological studies made at the local hospital revealed a fracture of the neck of the radius with marked displacement of the proximal radial epiphysis (Fig 1). Due to difficulties of transportation from her island community, the patient remained overnight in the local hospital and arrived at the Massachusetts General Hospital 36 hours following her injury.
The admission physical examination was entirely normal except for the left elbow which was markedly swollen and tender. The arm was held in 45° of flexion at the elbow and 10° of pronation of the forearm. The patient resisted any attempt to move from this position either actively or passively. The patient also refused