Radial head subluxation

Background

• Radial head subluxation due to longitudinal traction on arm
  • Annular ligament of radius displaces into radiocapitellar articulation
• Age 1y-5y (peak 2y-3y)

Diagnosis

• Sudden onset
• Absence of edema, focal tenderness, or bruising
  • If these features are present, consider x-ray and alternative diagnosis

Management

• Reduce
  • Hyperpronation Technique
    • Hold pt's elbow at 90 degrees with one hand
    • With other hand hyperpronate pt's wrist
  • Supination Technique
    • Hold pt's elbow at 90 degrees with one hand
    • With other hand supinate pt's wrist and flex elbow
• If successful pt will have FROM w/in 30min
• If unsuccessful after multiple attempts obtain x-ray
  • If negative immoblize arm in sling, outpt ortho f/u w/in 1wk

Source

Tintinalli