If severe beta-lactam allergy, clindamycin IV 900 mg every 8 hours
Gross contamination or farm injury
Add gentamicin IV 5 mg/kg once daily
Tetanus prophylaxis
Unknown or incomplete immunization
Tetanus toxoid vaccine
Tetanus immune globulin
Up to date immunization
Booster per schedule and wound risk
DVT prophylaxis when relevant
Thrombosis prevention
Not routine for isolated upper extremity immobilization
Low baseline VTE risk
Individualized consideration
Prior VTE history
Active malignancy
Prolonged immobility
Alignment with local protocol
Documentation of rationale
Special Populations
Pregnancy
Pregnancy considerations
Imaging safety
Elbow radiographs acceptable with shielding when feasible
CT only when benefits outweigh risks
Analgesia
Acetaminophen preferred first line
NSAIDs avoidance in later pregnancy per obstetric guidance
Disposition
Lower threshold for pain control and follow-up reliability
Geriatric
Older adult considerations
Fragility mechanism relevance
Low-energy FOOSH
Osteoporosis risk
Medication risks
NSAID renal and GI risk
Opioid delirium and fall risk
Function and supports
ADL limitation with dominant arm injury
Higher support needs for discharge
Pediatrics
Pediatric considerations
Differential shift
Radial neck fracture more common
Supracondylar fracture consideration
Growth plate considerations
Physeal injury evaluation
Nursemaid elbow mimic
Traction mechanism
Refusal to use arm
Analgesia dosing
Weight-based acetaminophen and ibuprofen per local protocol
Background
Epidemiology
Epidemiology
Frequency context
Common adult elbow fracture pattern
FOOSH mechanism predominance
Associated injury prevalence
Ligament injury common with displaced patterns
Elbow dislocation association in Mason IV
Pathophysiology
Pathophysiology
Anatomy
Radial head role in valgus stability
Radial head role in longitudinal forearm stability
Injury mechanics
Axial load through radius to capitellum
Valgus and rotational forces with ligament injury
Complication mechanisms
Stiffness from prolonged immobilization
Chronic instability when ligament injury missed
Proximal radial migration with interosseous membrane disruption
Therapeutic Considerations
Therapeutic rationale
Early motion importance
Stiffness risk reduction
Functional recovery improvement
Nonoperative strategy
Stable nondisplaced fractures with no block
Operative strategy triggers
Mechanical block
Instability
Comminution with loss of radiocapitellar congruity
Evidence framing
Early mobilization favored for stable Mason I and selected Mason II patterns
Operative management often required for Mason III and Mason IV due to instability risk
Guideline style evidence labels
Early mobilization for stable fractures as ACEP Level B style practice standard
Urgent consultation for elbow instability as Class I consensus style recommendation
Patient Discharge Instructions
Copy discharge instructions
Discharge instructions
Immobilization care
Sling or splint kept clean and dry
Avoid tightening wraps if swelling increases
Swelling control
Elevation above heart as much as possible for 48 to 72 hours
Ice 15 to 20 minutes at a time, several times daily
Activity limits
No lifting or pushing with injured arm
Avoid sports until cleared
Motion guidance
If instructed as stable, gentle elbow motion within pain limits after short rest period
Stop if mechanical block or severe pain occurs
Pain plan
Acetaminophen as directed
Ibuprofen as directed if safe
Opioid only if prescribed, no driving after use
Return to ED now
Increasing pain not controlled with medication
New numbness or weakness in hand or fingers
Inability to extend fingers or thumb
Hand becoming pale, cool, or increasingly swollen
Severe forearm tightness or pain with finger movement
Wet, broken, or too-tight splint
Fever, redness, drainage, or worsening wound pain
Follow-up
Orthopedics or fracture clinic within 7 days
Earlier follow-up if dislocation, block, or instability concern
References
Guidelines and evidence sources
Key references
Mason radial head fracture classification original description
Orthopedic trauma reference standards for radial head fracture management
AAOS related guidance on upper extremity fracture care principles
Procedural sedation safety standards for ED reductions
Consensus recommendations on early motion for stable elbow fractures
Literature on Essex-Lopresti injury recognition and management
ATLS principles for high-energy trauma screening and associated injury evaluation
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.