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You are asked to see a stable multiple-trauma patient, 26 years old, who has fallen out of a tree (and you thought only kids climbed trees). He is intoxicated, and apparently fell striking his right side. The brunt of the fall was borne by the right arm, and he is unable to move his right elbow. He is complaining of severe pain. A screening head-to-toe trauma exam shows him to be alert &ox3, wearing a c-collar, and with some bruising of the right hip and thigh but no other findings. Vitals show only tachycardia. The right forearm is swollen just below the elbow, and the patient complains of severe pain with pronation/supination. Pulses and neuro function are intact distally.

A routine trauma evaluation is ordered, including CT of head-cspine-chest-abd-pelvis (the “Full Monty”). You order a portable chest and R elbow to include the proximal forearm, as well as the pelvis and R femur views. Pain meds are given, with good result.

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What does the X-ray show?
What is your next move?

Conclusion on next page

 

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