A 26-year-old male presents with pain to his left elbow after falling from a skateboard. He has mild tenderness with pronation and supination; the rest of the exam is unremarkable. An X-ray is shown. What is the next best step in management?

• A. Sling and orthopedic referral
• B. Immediate surgical intervention
• C. Physical therapy and return to activity in 2 weeks
• D. Ice, elevation, and observation only

Answer: (A)

In elbow injuries, securing the injured part and getting specialist input is essential when imaging shows a fracture or potential instability. Immobilizing the elbow with a sling protects the fracture fragments, reduces pain, and prevents further displacement while you arrange definitive management.

This patient’s fall with focal elbow tenderness and a radiograph consistent with a fracture calls for immobilization now and an orthopedic referral to determine whether conservative treatment or surgical fixation is needed based on displacement and joint involvement. Immediate surgery isn’t automatically required, and waiting with only ice and observation could allow a fracture to worsen. Early physical therapy or activity is inappropriate while a fracture is being assessed.