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Radial Head Subluxation
Radial Head Subluxation
Radial Head Subluxation
Radial Head Subluxation
Radial Head Subluxation
Radial Head Subluxation
Radial Head Subluxation
Radial Head Subluxation
Radial Head Subluxation
Radial Head Subluxation
Radial Head Subluxation
Radial Head Subluxation
Radial Head Subluxation
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Radial Head Subluxation

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  • 1. Radial Head SubluxationRadial Head Subluxation andand Associated ComplicationsAssociated Complications Aimee DisharoonAimee Disharoon December 14, 2005December 14, 2005
  • 2. Radial Head SubluxationRadial Head Subluxation  AKA “Nursemaids’ Elbow”AKA “Nursemaids’ Elbow”  Common injury that is seen most often inCommon injury that is seen most often in children between the ages of 1-6 yearschildren between the ages of 1-6 years  Occurs when longitudinal traction is placed onOccurs when longitudinal traction is placed on the hand while the elbow is extended and thethe hand while the elbow is extended and the forearm pronated.forearm pronated.  Usually occurs when child falls and continues toUsually occurs when child falls and continues to be held by the hand, or when small children arebe held by the hand, or when small children are swung by their arms.swung by their arms.
  • 3. AnatomyAnatomy  The annular ligament normally passes around the proximal radius just below the radial head. With traction on the extended arm, the annular ligament slides over the head of the radius into the joint space and becomes entrapped  Common early childhood injury becauseCommon early childhood injury because at an early age, the radial head is sphericalat an early age, the radial head is spherical and is composed mainly of cartilageand is composed mainly of cartilage
  • 4. Clinical PresentationClinical Presentation  history of arm being pulledhistory of arm being pulled  injured elbow pronated, partially flexed and heldinjured elbow pronated, partially flexed and held by side, child will not useby side, child will not use  there is anterolateral tenderness over the radialthere is anterolateral tenderness over the radial headhead  no swelling, redness, warmth, abrasions, orno swelling, redness, warmth, abrasions, or ecchymosisecchymosis  have been reports of infants < 6 months oldhave been reports of infants < 6 months old with a history of not using arm after rolling overwith a history of not using arm after rolling over and their arms getting caughtand their arms getting caught
  • 5. RadiographsRadiographs  Diagnosis is by history and physical examination.Diagnosis is by history and physical examination. Radiograph examination is usually not necessaryRadiograph examination is usually not necessary and are normal in most instances.and are normal in most instances.  If x-rays are taken, often the subluxation isIf x-rays are taken, often the subluxation is reduced when the technician positions the armreduced when the technician positions the arm on the plate.on the plate.  Radiographs become necessary if pain continuesRadiographs become necessary if pain continues post-reduction.post-reduction.
  • 6. ReductionReduction  Cup affected elbow withCup affected elbow with opposite handopposite hand  Apply pressure over radialApply pressure over radial headhead  Thumb in antecubital fossaThumb in antecubital fossa  Apply slight longitudinalApply slight longitudinal traction by grasping wristtraction by grasping wrist  Supinate (palm up) and flexSupinate (palm up) and flex (to 90 degrees) forearm(to 90 degrees) forearm  Palpable click felt withPalpable click felt with reductionreduction
  • 7. Post-reduction ManagementPost-reduction Management  Child should be pain-free and use arm withinChild should be pain-free and use arm within 0-15 minutes. Immobilization optional (Sling for 1-20-15 minutes. Immobilization optional (Sling for 1-2 days)days)  If child fails to use arm after 15 minutes, obtain elbowIf child fails to use arm after 15 minutes, obtain elbow views to rule out concomitant fractureviews to rule out concomitant fracture  If x-rays normal but child still not using arm, use aIf x-rays normal but child still not using arm, use a posterior splint and sling and re-evaluate in 24 hoursposterior splint and sling and re-evaluate in 24 hours  If child has 3 recurrent episodes of subluxation, thenIf child has 3 recurrent episodes of subluxation, then apply hard cast for 3 weeksapply hard cast for 3 weeks
  • 8. Elbow X-rayElbow X-ray  Views:Views:  APAP  ObliqueOblique  LateralLateral  Technique:Technique:  Elbow in 90 degreeElbow in 90 degree flexionflexion  Compare with oppositeCompare with opposite elbowelbow  EvaluationEvaluation::  The radial head shouldThe radial head should always point at thealways point at the capitellum in all views. Acapitellum in all views. A line drawn down the longline drawn down the long axis of the radius (radialaxis of the radius (radial head) should intersect thehead) should intersect the capitellum in all views (ifcapitellum in all views (if the line doesn’t intersect,the line doesn’t intersect, this is a sign ofthis is a sign of dislocation)dislocation)
  • 9. ComplicationsComplications  If pain does not subsideIf pain does not subside post-reduction, then suspectpost-reduction, then suspect fracture (x-rays required)fracture (x-rays required)  Supracondylar FractureSupracondylar Fracture /Salter-Harris Fracture/Salter-Harris Fracture  Monteggia FractureMonteggia Fracture  Green Stick FractureGreen Stick Fracture Fractures can be seen as lines tranversing the bone, displace- ment of one end of bone relative to the other end, and as joint effusions or “fat pads”
  • 10. Supracondylar FractureSupracondylar Fracture  True supracondylar fracturesTrue supracondylar fractures typically occur just above thetypically occur just above the humeral epicondyleshumeral epicondyles  Salter-Harris fractures occurSalter-Harris fractures occur in the epiphysis of thein the epiphysis of the humerus, are subtle and oftenhumerus, are subtle and often hard to differentiate fromhard to differentiate from dislocations (line drawndislocations (line drawn through the radius intersectsthrough the radius intersects with capitellum)with capitellum)
  • 11. Monteggia FractureMonteggia Fracture  Fracture of theFracture of the proximal third of ulnaproximal third of ulna with radial headwith radial head dislocationdislocation
  • 12. Green Stick FractureGreen Stick Fracture  Incomplete fracture ofIncomplete fracture of the radius or ulna whichthe radius or ulna which causes “bowing” of thecauses “bowing” of the bonebone
  • 13. ReferencesReferences  Choung, Walter, and Heinrich,Stephen. AcuteChoung, Walter, and Heinrich,Stephen. Acute Annunlar Ligament Interposition into theAnnunlar Ligament Interposition into the Radiocapitellar Joint in Children (Nursemaid's Elbow).Radiocapitellar Joint in Children (Nursemaid's Elbow). Journal of Pediatric Orthopedics. Vol. 15, No.4 1995Journal of Pediatric Orthopedics. Vol. 15, No.4 1995  Waander, Hellerstein, and Ballock. Nursemaid's Elbow,Waander, Hellerstein, and Ballock. Nursemaid's Elbow, Pulling out the Diagnosis. Contemporary Pediatrics.Pulling out the Diagnosis. Contemporary Pediatrics. June 2000June 2000  Nursemaid’s Elbow, Familypracticenotebook.comNursemaid’s Elbow, Familypracticenotebook.com  Riego de Dios, Ricardo, and Norris, Burl. ElbowRiego de Dios, Ricardo, and Norris, Burl. Elbow Fractures and Dislocations. eMedicine. July 2004Fractures and Dislocations. eMedicine. July 2004

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