title: Does preservation of active range of motion after acute elbow injury rule out the need for radiography?
abstract: BACKGROUND
  We aimed to evaluate the role of a normal elbow active range of motion (ROM) in predicting low fracture risk and avoiding elbow X-ray in patients with acute elbow injuries. Lack of any approved rules for this purpose led us to evaluate simple physical examination methods to predict elbow fractures.
  
  
  METHODS
  In this observational study, all patients with elbow injury who presented to two emergency departments were enrolled according to specific criteria. Patients were examined by emergency or orthopedics residents. Elbow radiographs were reviewed by a radiologist for fractures and soft tissue injuries. Results of the clinical examination and radiographs were recorded for statistical analysis. Sensitivity, specificity and positive and negative predictive values were calculated.
  
  
  RESULTS
  Elbow fractures were identified in 10 of the 102 enrolled patients (9.8%). Nine of the 10 had limited ROM in all movements. Limited active elbow ROM in predicting elbow fracture revealed a sensitivity of 90%, specificity of 92%, and positive and negative predictive values of 56% and 98%, respectively. Individuals with limitation in one or two directions had no signs of fracture in the X-rays.
  
  
  CONCLUSIONS
  Patients with elbow injury and a limited ROM in all directions of flexion, extension, supination and pronation require further X-ray investigations.
authors.affiliation: Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hassan
authors.initials: H
authors.lastname: Amiri
authors.forename: Samad
authors.initials: S
authors.lastname: Shams Vahdati
authors.forename: Sanaz
authors.initials: S
authors.lastname: Fekri
authors.forename: Shayan Abdollah
authors.initials: SA
authors.lastname: Zadegan
authors.forename: Hamid
authors.initials: H
authors.lastname: Shokoohi
authors.forename: Vafa
authors.initials: V
authors.lastname: Rahimi-Movaghar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004550:Elbow / Q000000981:diagnostic imaging; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D056740:Olecranon Process / Q000293:injuries; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D017695:Soft Tissue Injuries / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D055815:Young Adult; D000092464:Elbow Injuries