Approach to the Critical Patient

Immediate neurovascular threats

Vascular emergency triggers

Compartment syndrome alert

Stabilization priorities

Initial stabilization steps

Consultation triggers

Orthopedic consultation indications

History

Mechanism and event

Fall on outstretched hand (FOOSH)

Acute symptom onset

Alarm symptoms

Neurovascular warning signs

Associated injury clues

Risk factors and context

Age and demographics

Non-accidental trauma screening

Past medical history relevant factors

Physical Exam

Vascular exam

Pulse assessment

Hand perfusion appearance

Neurologic exam

Anterior interosseous nerve (AIN) function

Median nerve function

Radial nerve function

Ulnar nerve function

Musculoskeletal and soft tissue exam

Inspection findings

Palpation

Pain with passive finger extension

PITFALLS

Common examination errors

Differential Diagnosis

Pediatric elbow fractures

Lateral condyle fracture

Medial epicondyle fracture

Radial head and neck fracture

Elbow dislocations and soft tissue

Elbow dislocation

Nursemaid's elbow (radial head subluxation)

Olecranon fracture

Other considerations

Occult fracture — fat pad sign only

Pathologic fracture

Non-accidental trauma

Laboratory Tests

Pre-operative assessment

Surgical planning labs

Electrolytes and renal function

Selective laboratory testing

Inflammatory markers

Routine labs not indicated

Diagnostic Tests

Scoring Systems

Gartland Classification (modified Wilkins/Leitch)

Vascular classification (Omid system)

MRI

MRI elbow role in supracondylar fractures

CT

CT elbow indications

CT chest or vascular CT

Ultrasound

Point-of-care ultrasound applications

Disposition

Admission indications

Mandatory admission criteria

Discharge criteria

Safe discharge requirements

Follow-up plans

Orthopedic follow-up timing

Treatment

Analgesia and sedation

Pain management

Procedural sedation for reduction

Immobilization — nondisplaced fractures

Type I fracture management

Closed reduction and percutaneous pinning (CRPP)

CRPP indications

Pin configuration options

Open reduction indications

Open reduction triggers

Vascular injury management

Class 2 (pink, pulseless) management

Class 3 (white, pulseless) management

Antibiotic therapy

Open fracture prophylaxis

Special Populations

Pregnancy

Pregnancy considerations

Geriatric

Geriatric distal humerus fracture considerations

Pediatrics

Pediatric-specific management considerations

Background

Epidemiology

Incidence and distribution

Complication rates

Pathophysiology

Fracture mechanism

Neurovascular anatomy at risk

Compartment syndrome mechanism

Therapeutic Considerations

Evidence base for CRPP

Lateral-only versus crossed-pin configuration

Pink pulseless hand controversy

Patient Discharge Instructions

copy discharge instructions

Supracondylar fracture home care instructions

Warning signs — return to emergency department immediately

Follow-up instructions

Expected recovery

References

Guidelines and key sources

Primary guidelines

Systematic reviews and landmark studies

Coding standards

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.