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Radial Head Subluxation: Factors Associated with Its Recurrence and Radiographic Evaluation in a Tertiary Pediatric Emergency Department.

Authors:
Kei Wong Alex B Troncoso Diane P Calello David Salo Fred Fiesseler

J Emerg Med 2016 Dec 27;51(6):621-627. Epub 2016 Sep 27.

Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.

Background: Radial head subluxation (RHS) is a common complaint seen in the pediatric emergency department in children ages 6 months to 4 years. Classically, injury occurs due to axial traction on the arm, but this mechanism is not universal. Some patients will have recurrent RHS; some may undergo x-ray (XR) evaluation for alternative diagnosis.

Objectives: To determine factors associated with recurrences and radiographic evaluations in RHS.

Methods: A retrospective study with inclusion criteria: under 10 years of age with discharge diagnosis "nursemaid," "radial head," or "subluxation." We examined factors associated with RHS recurrences, circumstances when radiographic evaluations performed, physician's training background (pediatric vs. general emergency medicine), mechanisms of injury, and demographic factors including age, gender, and arm involved.

Results: In 246 visits, median age was 27 months (interquartile range 16.1), with females comprising 55.7% (n = 137), and left-sided predominance (52%, n = 130). Mechanisms of injury were classified as "pull" (65.9%, n = 162), "non-pull" (15.9%, n = 39), and "unknown" (18.3%, n = 45). Eighteen patients with recurring RHS were more likely to be male (p = 0.008). In 61 visits where radiography was performed, patients were older (p = 0.03), with a higher frequency seen in non-pull and unknown mechanism (p = 0.0001). No significant difference was found in frequency of radiographs obtained in regard to physician training (p = 0.4660).

Conclusion: RHS can result from a myriad of mechanisms. We found that recurrence was more likely in male patients. Factors associated with radiographic evaluation included atypical mechanism, older age, and unclear history, regardless of physician training background.

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http://dx.doi.org/10.1016/j.jemermed.2016.07.081DOI Listing
December 2016

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