Pediatrics 417397.A 5-year-old boy who fell from the monkey bars and landed on his left
elbow is brought into the ED for evaluation. The patient has no significant
medical history. On physical examination, you note the patient is holding
his left arm in an adducted position. There is obvious swelling around the
elbow with decreased range of motion secondary to pain. He complains of
hand numbness, but the motor and vascular examination is normal. The
radiograph shown below shows posterior displacement of the capitellum
with evidence of a dark shadow posterior to the distal humerus. Which of
the following is the most serious complication associated with this injury?
a. Transection of the brachial artery
b. Malunion of distal humerus
c. Motor deficit from injury to the ulnar nerve
d. Chronic arthritis of the elbow
e. Chronic deformity of the hands and fingers caused by contractures
(Reproduced, with permission, from Simon RR, Sherman SC, Koenigsknecht SJ.Emergency
Orthopedics: The Extremities.5th ed. New York, NY: McGraw-Hill; 2007: Figure 6-18.)