Supracondylar fracture (grade I)
Fall from bike. Not using arm. Elbow swelling. Will not extend elbow.
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Elbow joint effusion with lucency across the supracondylar region on the AP x-ray and cortical irregularity posteriorly and medially.
Supracondylar fractures are the most common childhood elbow fracture. The anterior humeral line usually comes to your aid when making this diagnosis, but where there is limited displacement (grade I) like in this case, you need to go looking for the fracture.
The elbow joint effusion heralds an intra-articular fracture and even if you can't see one, it's almost certainly a supracondylar fracture.