Does preservation of active range of motion after acute elbow injury rule out the need for the radiography?

Objective: To evaluate the role of a normal elbow active range of movements (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 fractures of elbow.
Methods: In this observational study, all patients with elbow injury presented to two emergency departments 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 clinical examination and radiographs were recorded for statistical analysis. Sensitivity, specificity, positive and negative predictive values were calculated.
Results: Elbow fractures were identified in 10 of 102 enrolled patients (9.8%), Nine out of 10 had limited ROM in all movements. Limited active elbow ROM in predicting elbow fracture were revealed a sensitivity of 90%, specificity of 92%, and a 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.
Conclusion: Patients with elbow injury and a limited ROM in all directions of flexion, extension, supination and pronation require further x-ray investigations.