Appelboam et al developed a simple decision rule for performing imaging studies in a patient following trauma to the elbow. This can reduce the number of unnecessary imaging studies. The authors are from several NHS hospitals in England.


Patient selection: trauma to the elbow in a patient >= 3 years of age



(1) The patient is seated.

(2) Both arms are exposed to view and supinated.

(3) Both arms are flexed at the shoulders to 90 degrees.

(4) The patient then tries to extend both arms until the elbows lock.


Radiographs should be taken if one or more of the following is present:

(1) the patient is unable to fully extend the injured elbow

(2) an olecranon fracture is suspected

(3) the patient is a child (3 to 15 years of age) and a significant injury occurred


If radiographs are not taken, then the patient is instructed to return if the pain worsens or does resolve in 7 to 10 days.


To read more or access our algorithms and calculators, please log in or register.