Radial head subluxation: Difference between revisions
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==Management== | ==Management== | ||
===Reduction=== | |||
''Hyperpronation has greater first try success rate (94% vs 69%), but both have similar overall reduction rate<ref>Pronation versus supination maneuvers for the reduction of 'pulled elbow': a randomized clinical trial. Eur J Emerg Med. 2009 Jun;16(3):135-8. doi: 10.1097/MEJ.0b013e32831d796a.</ref>; consider doing both techniques at once in quick succession'' | |||
*Hyperpronation Technique | |||
**Hold patient's elbow at 90 degrees with one hand | |||
**With other hand hyperpronate patient's wrist | |||
*Supination Technique | |||
**Hold patient's elbow at 90 degrees with one hand | |||
**With other hand supinate patient's wrist and flex elbow | |||
===Post-Reduction=== | |||
*If successful patient will have FROM within 30min | *If successful patient will have FROM within 30min | ||
*If unsuccessful after multiple attempts, obtain x-ray | *If unsuccessful after multiple attempts, obtain x-ray and consider alternative diagnoses (e.g. [[salter harris fracture]]) | ||
==Disposition== | ==Disposition== | ||
Revision as of 10:41, 4 December 2016
Background
- Radial head subluxation due to longitudinal traction on arm
- Annular ligament of radius displaces into radiocapitellar articulation
- Age 1y-5y (peak 2y-3y)
Clinical Features
- Sudden onset
- Typical history: Sudden pull on extended arm. Swinging the child by adult while playing.
- Absence of edema, focal tenderness, or bruising
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
- If classic history/physical --> proceed directly to reduction maneuver without imaging
- If unclear or atypical history/physical --> consider x-ray first and/or alternative diagnosis
Management
Reduction
Hyperpronation has greater first try success rate (94% vs 69%), but both have similar overall reduction rate[1]; consider doing both techniques at once in quick succession
- Hyperpronation Technique
- Hold patient's elbow at 90 degrees with one hand
- With other hand hyperpronate patient's wrist
- Supination Technique
- Hold patient's elbow at 90 degrees with one hand
- With other hand supinate patient's wrist and flex elbow
Post-Reduction
- If successful patient will have FROM within 30min
- If unsuccessful after multiple attempts, obtain x-ray and consider alternative diagnoses (e.g. salter harris fracture)
Disposition
- If reduced and moving arm, outpatient
See Also
References
- ↑ Pronation versus supination maneuvers for the reduction of 'pulled elbow': a randomized clinical trial. Eur J Emerg Med. 2009 Jun;16(3):135-8. doi: 10.1097/MEJ.0b013e32831d796a.