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Prior studies found the elbow extension test to be sensitive for fracture after acute trauma (NEJM JW Gen Med Jan 13 2009; NEJM JW Emerg Med Jan 23 2009; Emerg Med J 2014; 31:380). Lack of full extension and presence of bony point tenderness or bruising were found to be 96% to 100% sensitive for fracture in several studies. Investigators from two emergency departments in the Netherlands evaluated the ability of full extension and absence of point tenderness to rule out fracture. All patients had elbow x-rays.
There were 587 participants (233 children and 354 adults), of whom 59% had a fracture. In both adults and children, 98% of fractures were detected by inability to extend the elbow fully or presence of point tenderness. Only one patient …