Radial head subluxation: Difference between revisions
| Line 22: | Line 22: | ||
==Evaluation== | ==Evaluation== | ||
* | *Clinical diagnosis | ||
* | **Patients with classic story and findings do not require imaging before reduction | ||
* | **Any child with an unclear story or unsuccessful reduction should undergo imaging to rule other pathology | ||
*Assess neurovascular status prior to (and following) reduction | |||
==Management== | ==Management== | ||
Revision as of 22:26, 13 May 2019
Background
- Radial head subluxation due to longitudinal traction on arm
- Annular ligament of radius displaces into radiocapitellar articulation
- Age 1y-5y (peak 2y-3y)
- After this point, the change in shape of the radial head with growth protects against subluxation
Clinical Features
- Typical history includes sudden longitudinal traction on the arm
- Swinging child by arms by playing
- Pulling child back from walking into traffic
- Catching child who is falling
- Younger children may sustain the injury by less classic mechanisms
- Sudden onset of pain
- Refusal to use the affected arm
- Arm held in extension
- Refusal to supinate
- Limited edema
- No 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
- Clinical diagnosis
- Patients with classic story and findings do not require imaging before reduction
- Any child with an unclear story or unsuccessful reduction should undergo imaging to rule other pathology
- Assess neurovascular status prior to (and following) reduction
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 return of full range of motion within 30min
- If unsuccessful after multiple attempts, obtain x-ray and consider alternative diagnoses (e.g. Salter-Harris fracture)
Disposition
- Discharge if successful reduction and return of use of arm
See Also
External Links
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.