Doctor: Good afternoon, who's the victim today, sir? Is it you, or your daughter? 
Guest_family: Good afternoon, doctor. It's my daughter today. 
Doctor: Remind me, how old is she? 
Patient: I'm thirteen, sir. 
Doctor: So, what happened? My nurses tell me she fell today.
Patient: Yeah, I fell off the swing at school earlier this afternoon at about one thirty.
Doctor: Where does it hurt, young lady?
Patient: It's really bad here on my left elbow. 
Doctor: Which hand do you write with?
Patient: I use my right hand for everything, thank goodness for that. 
Doctor: Before seeing me, have you seen anyone else?
Guest_family: Yeah, we went to an Urgent Care and she had an x ray there. 
Doctor: What else did they do?
Guest_family: They said her arm was broken, and they tried to do a reduction.
Doctor: Do you have those x rays with you right now?
Guest_family: Yeah, I have them right here, take a look, please. 
Doctor: Well, these x rays show an incarcerated medial epicondyle fracture, as well as a mildly angulated radial shaft break. 
Patient: What does that mean?
Doctor: Well, in short, you broke the inside part of your elbow. In addition to the pain, do you have any burning or tingling feelings in that arm?
Patient: Yes, I do. 
Doctor: Did you have this before they tried to do a reduction?
Patient: No, I didn't, this is new. 
Doctor: Is this feeling getting worse? 
Patient: Yes, it is. 
Doctor: Okay, guys, there is a lot of pressure on that ulnar nerve because of the break and the attempted reduction. 
Guest_family: What should we do?
Doctor: We need to do an O R I F procedure A S A P. I'll reduce that radial shaft fracture at the same time.
Guest_family: O R I F? What's that
Doctor: I'll put some pins in the elbow, in order to stabilize the break, and we can start the healing process. 
Guest_family: Will this not heal on its own? 
Doctor: No, we need to do the surgery. 
Guest_family: Okay, what are the risks of infection with the surgery? 
Doctor: Historically, its less than one percent. 
Guest_family: How is this possible?
Doctor: We use prophylactic antibiotics, this helps us control for infection the entire time. 
Guest_family: Will she be asleep for this?
Doctor: Yes, she won't feel a thing. 
Guest_family: Will she need this hardware taken out in the future?
Doctor: Yes, in about a year or two, after everything is healed up nicely. The other risks include bleeding, changes in sensation and motion of the extremity, and hardware failure. I see good results from my surgeries so I would not worry about these things, but I must disclose.
Guest_family: Okay, yes, we'd like to do the surgery.

Clinical note:
Symptoms: fell off a swing, pain in left elbow, burning or tingling feelings in left arm
Diagnosis: incarcerated medial epicondyle fracture, mildly angulated radial shaft break
History of Patient: fell off swing at school, initially seen at Urgent Care with attempted closed reduction, increased ulnar paresthesias post-procedure
Plan of Action: urgent open reduction and internal fixation to relieve pressure on ulnar nerve, reduce radial shaft fracture, explained risks of surgery including anesthesia, infection, bleeding, changes in sensation and motion, hardware failure, need for later hardware removal, and possible continuous nerve Symptoms, father agreed to surgery