Radial Head Subluxation: Possible Effective Factors on Time to Re-use the Affected Limb

  • Farhad Heydari Emergency Medicine Research Center, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. https://orcid.org/0000-0002-6296-0045
  • Babak Masoumi Emergency Medicine Research Center, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. https://orcid.org/0000-0002-5928-1770
  • Shiva Samsamshariat Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Keywords: Child, Elbow joint, Joint dislocations, Radius, Time perception


Introduction: Radial head subluxation (RHS) is a common disorder in children. Although it is not accompanied by any important short- or long-term sequel, it could make the parents worried about. Objective: The purpose of this study was to determine the possible effective factors that may influence time to use the affected limb. Methods: This cross-sectional study was conducted prospectively during the years 2014 to 2016. All children under the age of 6 years who visited the emergency department (ED) and were diagnosed as having RHS were eligible. The patients’ baseline information was recorded. After the reduction, the time until the affected arm use returned was recorded. The possible relationship between the baseline data and time to re-use the affected limb was assessed. Results: During the study period, 112 children with a mean age of 30.18 ± 18.18 months were evaluated (53% male). Among the children who visited the ED during the first 4 hours and thereafter, 84% and 60%, respectively, re-used their limb in less than 10 minutes after reduction (p = 0.004). Also, 55% of children less than or equal to 24 months and 89% over the age of 24 months re-used the arm in 10 minutes (p < 0.001). The success rate of the first reduction maneuver was significantly lower in children with a recurrent dislocation (p = 0.001). Conclusion: It is likely that age less than or equal to 24 months and ED visit after 4 hours of the event lead to a longer duration for re-using the affected arm following reduction.


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1. Krul M, van der Wouden J, Koes B, Schellevis F, van Suijlekom-Smit L. Nursemaid's elbow: Its diagnostic clues and preferred means of reduction. J Fam Pract. 2010;59(1):E5-7.
2. Kim M, Eckhardt B, Craig C, Kuhns L. Ultrasonography of the annular ligament partial tear and recurrent" pulled elbow". Pediatr Radiol. 2004;34(12):999-1004.
3. Krul M, van der Wouden JC, Kruithof EJ, van Suijlekom‐Smit LW, Koes BW. Manipulative interventions for reducing pulled elbow in young children. Cochrane Database Syst Rev. 2017;7:CD007759.
4. Sevencan A, Aygun U, Inan U, Omeroglu H. Pulled elbow in children: a case series including 66 patients. J Pediatr Orthop B. 2015;24(5):385-8.
5. Brown D. Emergency department visits for nursemaid's elbow in the United States, 2005-2006. Orthop Nurs. 2009;28(4):161-2.
6. Rudloe TF, Schutzman S, Lee LK, Kimia AA. No longer a "nursemaid's" elbow: mechanisms, caregivers, and prevention. Pediatr Emerg Care. 2012;28(8):771-4.
7. Welch R, Chounthirath T, Smith GA. Radial Head Subluxation Among Young Children in the United States Associated With Consumer Products and Recreational Activities. Clin Pediatr (Phila). 2017;56(8):707-15.
8. Makhni MC, Makhni EC, Swart EF, Day CS. Radial Head Subluxation (Nursemaid’s Elbow). Orthopedic Emergencies: Springer; 2017. p. 431-2.
9. Vitello S, Dvorkin R, Sattler S, Levy D, Ung L. Epidemiology of Nursemaid’s Elbow. West J Emerg Med. 2014;15(4):554-7.
10. Irie T, Sono T, Hayama Y, Matsumoto T, Matsushita M. Investigation on 2331 Cases of Pulled Elbow Over the Last 10 Years. Pediatr Rep. 2014;6(2):5090.
11. Rodts MF. Nursemaid's elbow: a preventable pediatric injury. Orthop Nurs. 2009;28(4):163-6.
12. Lewis D, Argall J, Mackway-Jones K. Reduction of pulled elbows. Emerg Med J. 2003;20(1):61-2.
13. Eismann EA, Cosco ED, Wall EJ. Absence of radiographic abnormalities in nursemaid's elbows. J Pediatr Orthop. 2014;34(4):426-31.
14. Wong K, Troncoso AB, Calello DP, Salo D, Fiesseler F. Radial Head Subluxation: Factors Associated with Its Recurrence and Radiographic Evaluation in a Tertiary Pediatric Emergency Department. J Emerg Med. 2016;51(6):621-7.
15. Makin CW, Vinson DR. A literature-based algorithm for the treatment of children with radial head subluxation who fail to respond to initial hyperpronation. Am J Emerg Med. 2017;35(9):1365-7.
16. Hung O, Nelson L. Tintinalli's emergency medicine: a comprehensive study guide. 8th edition ed. New York: McGraw-Hill; 2016. p. 983-4.
17. Heydari F, Samsam Shariat S, Majidinejad S, Masoumi B. The use of ultrasonography for the confirmation of pulled elbow treatment. JEPT. 2018;4(1):24-8.
18. Asadi K, Mardani M. Comparison the Method of wrist Supination with Elbow Flexion as Classical Method with Hyperpronation Method in Reduction of Radial Head Subluxation in Less than 7 Years Old Children. J Guilan Univ Med Sci. 2011;20(77):55-60.
19. Kaplan RE, Lillis KA. Recurrent nursemaid's elbow (annular ligament displacement) treatment via telephone. Pediatrics. 2002;110(1 Pt 1):171-4.
20. Dixon A, Clarkin C, Barrowman N, Correll R, Osmond MH, Plint AC. Reduction of radial-head subluxation in children by triage nurses in the emergency department: a cluster-randomized controlled trial. CMAJ. 2014;186(9):E317-23.
21. Macias CG. Radial head subluxation. Acad Emerg Med. 2000;7(2):207-8.
How to Cite
Heydari, F., Masoumi, B., & Samsamshariat, S. (2018). Radial Head Subluxation: Possible Effective Factors on Time to Re-use the Affected Limb. Advanced Journal of Emergency Medicine, 2(2), e19. https://doi.org/10.22114/ajem.v0i0.70
Original article