Radiology Review

Man Run Over By Vehicle

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After accidentally being run over by a vehicle, a 54-year-old man presents to the emergency department for evaluation of pain in his elbow and left arm. He was leaning down behind the vehicle and was not seen when the driver backed up. The patient states that one of the tires went over his left shoulder and arm. Primary complaint is pain and decreased range of motion. He denies any significant medical history, except for medication-controlled hypertension and gallbladder surgery. His vital signs are stable. Exammination of the left arm demonstrates some abrasions and contusions over the shoulder and forearm, as well as some swelling over the elbow. The patient has good color, distal pulses, and sensation. There is localized tenderness over the elbow and midforearm. Flexion of the elbow is somewhat limited secondary to pain. Radiograph of the forearm is obtained and shown. What is your impression?


 

ANSWER

The radiograph shows some deformity within the mid-to-distal diaphysis of both the radius and ulna; however, no acute fracture is seen. This is most likely related to remote trauma.

Of note, closer to the elbow, there are some small avulsion fractures near the area of the lateral epicondyle. The patient was treated with a posterior splint and referred to orthopedics.

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