obtained In many cases, the radiographic studies provide the diagnosis (e.g., fracture, dislocation) Normal radiographs in the setting of acute trauma usually imply soft tissue injury and the patient should be treated symptomatically with close follow-up, provided that neurovascular integrity is established If radiographs appear normal but the child has reproducible tenderness localized to the epiphyseal plate, then the patient should be presumptively treated for a Salter– Harris type I fracture Occasionally, a child with a nursemaid’s elbow may have an atypical history (e.g., “fell onto arm”); if radiographs exclude a fracture but the patient is holding the arm in a characteristic position, an attempt at reduction should be performed Children with neurologic abnormalities should be evaluated urgently to localize the site and cause of the impairment A thorough neurologic examination, including examination of reflexes, motor function, and sensation, is imperative Based on findings, appropriate imaging and/or consultation with a neurologist or neurosurgeon should be pursued