https://upload.orthobullets.com/topic/4012/images/subluxation of radial head.jpg
https://upload.orthobullets.com/topic/4012/images/nursemaid flexion_supination.jpg
https://upload.orthobullets.com/topic/4012/images/nursemaid hyperpronation.jpg
  • Also known as subluxation of radial head 
  • Epidemiology
    • most common in children from 2 to 5 years of age.
  • Pathophysiology
    • mechanism
      • caused by longitudinal traction applied to an extended arm
    • pathoanatomy
      • caused by subluxation of the radial head and interposition of the annular (orbicular)  ligament into the radiocapitellar joint. 
  • Symptoms
    • a child with radial head subluxation tends to hold the elbow in slight flexion and the forearm pronated.
  • Physical Exam
    • pain and tenderness localized to the lateral aspect of the elbow.
  • Radiographs
    • recommended views
      • not routinely indicated in presence of classic history and physical examination
    • findings
      • radiographs are normal

Pediatric Elbow Injury Frequency & Treatment

Fracture Type % elbow injuries Peak Age Requires OR
Supracondylar fractures 41% 7  majority
Radial Head subluxation 28% 3  rare
Lateral condylar physeal fractures 11% 6 majority 
Medial epicondylar apophyseal fracture 8% 11 minority 
Radial Head and Neck fractures 5% 10 minority 
Elbow dislocations 5% 13 rare 
Medial condylar physeal fractures 1% 10 rare 
  • Nonoperative
    • closed reduction 
      • indications
        • acute cases
  • Operative
    • open reduction
      • indications
        • chronic injuries 
  • Closed reduction of radial head subluxation 
    • reduction techniques
      • reduction is performed by manually supinating the forearm and flexing the elbow past 90 degrees of flexion.   
      • while holding the arm supinated the elbow is then maximally flexed 
      • during this maneuver the physician’s thumb applies pressure over the radial head and a palpable click is often heard with reduction of the radial head.
      • alternative technique includes hyperpronation of the forearm while in the flexed position. 
    • followup
      • immobilization is not necessary and the child may immediately resume use of the arm.
      • follow up is only needed if the child does not resume normal use of his arm in the following weeks.
  • Recurrence
    • occurs in 5% to 39% of cases, but generally ceases after 5 years of age.

Please rate topic.

Average 4.3 of 32 Ratings

Questions (2)
Topic COMMENTS (9)
Private Note