Aims To provide a safeguarding perspective and review of infants with a diagnosis of pulled elbow presenting to a local Paediatric Accident and Emergency (A&E) Department.

Methods This was a retrospective review of Infants under 12 months of age with a diagnosis of pulled elbow presenting to the paediatric A&E unit over 12 months from January 2012.

The A&E records were reviewed for variables such as whether a background check with social care was performed, the explanation for the injury, whether it was witnessed and if the elbow was manipulated successfully. The hospital’s results server was checked for any relevant radiology reports and hospital medical notes were reviewed when indicated to complement the A&E records.

The final outcome category for each case was reached by consensus between a named doctor for child protection and two senior paediatric registrars.

Results 50 infants, age range 2 to 11 months, were coded with a diagnosis of pulled elbow with an average age of 7 months. 12% of cases had a documented whole body examination and only one case had a social care check performed.

72% of cases were likely pulled elbows and 1/3 of these were from mechanisms not well documented that included the arm being trapped under the body when rolling or being rolled.

12% were unwitnessed injuries and 8% had insufficient documentation to be categorised.

8% of cases were not pulled elbows and of these 75% (3 out of 4 cases) were either a confirmed or occult fracture, none of which were referred for a child protection medical. Successful manipulation was less likely in these cases.

Conclusions A large number of infants are seen yearly with an accidental pulled elbow. Acceptable mechanisms of injury in this age group include pulling arms through clothing and the arm being trapped under the body when rolling or being rolled. All presentations provide an opportunity for safe handling education.

A complete examination is essential when evaluating an infant with a possible pulled elbow and if the elbow cannot be manipulated then there should be a high suspicion for a fracture and appropriate radiology should be performed with discussion and referral to paediatrics.