Elbow Injuries: Radial Head Subluxation

Classic Presentation

• Age 1-4 years
• Occurs by pulling of extended and pronated arm
• Patient refuses to use arm
• Elbow in slight flexion/pronation
• Elbow appears atraumatic
• No focal elbow tenderness

X-ray Views

• Xrays rarely indicated
• Obtain xray if concerned for fracture, unable to reduce elbow, or inability to move arm post reduction

Acute Management

• Technique: Closed reduction with hyperpronation or supination/flexion approach
• If concern for supracondylar fracture, do not reduce and obtain xray first.

Follow-Up Timing

• Routine follow-up with pediatrician

References

• Wheeless’ Textbook of Orthopaedics. Available at: http://www.wheelessonline.com/ortho/nursemaids_elbow_radial_head_subluxation. Accessed August 1, 2017.
• Orthobullets. Available at: http://www.orthobullets.com/pediatrics/4012/nursemaids-elbow. Accessed August 1, 2017.
• Radiopaedia. Available at: http://radiopaedia.org/articles/radial-head-dislocation. Accessed August 1, 2017.
• General Guidelines For Management for Orthopedic Injuries card by the Nationwide Children’s Hospital, Department of Orthopedics