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Range of elbow movement as a predictor of bony injury in children
  1. Michael Baker,
  2. Meredith Borland
  1. Princess Margaret Hospital, Western Australia, Australia
  1. Correspondence to Dr Michael Baker, Princess Margaret Hospital, Roberts Road, Subiaco, GPO Box D184, Perth 6840, Western Australia, Australia; michael.r.baker{at}


Background The aim of this study was to determine whether a normal range of elbow movement can be used as a rule out tool for significant injury after blunt trauma in the paediatric population.

Methods A prospective observational study was set up in an Australian tertiary paediatric emergency department. Patients from 3 to 16 years old were included. Active range of elbow movement (flexion, extension, supination and pronation) was recorded as either normal or abnormal. All participants received standard elbow x-rays. Range of movement (ROM) was compared to the radiologist's final x-ray report. An x-ray was considered abnormal if it showed a fracture, dislocation or isolated elbow effusion.

Results 177 patients were included in the study, of which all received elbow x-rays. 146 had a restricted ROM (82%). 106 x-rays were reported as abnormal (60%). An abnormal ROM had a sensitivity of 93.4% (95% CI 86.9% to 97.3%), specificity 33.8% (95% CI 23.0% to 46.0%) and negative predictive value of 77.4% (95% CI 58.9% to 90.4%) for an abnormal x-ray. There were seven false-negative results in this group. Clinical management was changed in four of these patients due to abnormalities seen on x-ray.

Conclusion In the setting of blunt trauma resulting in elbow injury in children, a normal ROM does not rule out a significant injury and should not be used as a screening tool.

  • Paediatrics
  • paediatric orthopaedics
  • musculo-skeletal
  • fractures and dislocations
  • trauma
  • extremity
  • clinical assessment
  • effectiveness
  • imaging
  • x-ray

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Princess Margaret Hospital Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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