title: Preservation of active range of motion after acute elbow trauma predicts absence of elbow fracture.
abstract: OBJECTIVE
  Previous studies indicate that an inability to fully extend the elbow after elbow trauma is indicative of fracture. We hypothesized that maintenance of active range of motion (ROM) of the elbow in flexion, extension, pronation, and supination after elbow trauma is very specific for the absence of fracture or effusion, and limitation of ROM is sensitive for fracture or effusion.
  
  
  METHODS
  This was a prospective observational study with convenience sampling of a carefully selected patient population. This would allow certain types of patients to be excluded from the study. Patients with elbow injury receiving radiographs and meeting enrollment criteria were enrolled between June 2006 and March 2007 at 4 emergency departments in the local region. Demographics, active ROM, and presence of point tenderness at the olecranon, epicondyles, and radial head were recorded by enrolling clinicians. All enrolled patients received standard elbow radiographs. Radiographs were reviewed by blinded radiologists for the presence of fracture and effusion. Sensitivity, specificity, and 95% confidence intervals (CIs) of examination findings were calculated.
  
  
  RESULTS
  One hundred thirteen patients were enrolled. Limitation of active ROM was 100% (95% CI, 0.93-1.00) sensitive for fracture or effusion. Preservation of active ROM was 97% (95% CI, 0.89-1.00) specific for the absence of fracture. Point tenderness was also highly sensitive but not specific.
  
  
  CONCLUSIONS
  Individuals with preservation of active ROM after acute elbow trauma have a very low risk of associated fracture and may not require radiographic studies.
authors.affiliation: Department of Emergency Medicine, Naval Medical Center, San Diego, CA 92134, USA. michael.darracq@med.navy.mil
authors.forename: Michael A
authors.initials: MA
authors.lastname: Darracq
authors.forename: David R
authors.initials: DR
authors.lastname: Vinson
authors.forename: Edward A
authors.initials: EA
authors.lastname: Panacek
mesh_terms: D000328:Adult; D002648:Child; D004550:Elbow / Q000000981:diagnostic imaging; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D000092464:Elbow Injuries