Radial head subluxation is frequently referred to as “nursemaid’s elbow”
The annular ligament of the radius displaces into the radiocapitellar articulation (FIGURE 92.1A)
A common injury in children between the ages of 2 and 5 years, after which the annular ligament strengthens and the injury becomes uncommon
INDICATIONS
Clinical suspicion of a nursemaid’s elbow based on:
Refusal to use affected arm
Typical posture: Affected arm adducted or held at the side, with the elbow slightly flexed and forearm pronated. The child is usually in no distress unless the arm is moved.
Suggestive mechanism of injury
CONTRAINDICATIONS
Gross deformity, swelling, or significant point tenderness suggesting fracture
General Basic Steps
Analgesia (if indicated)
Patient preparation
Reduction
Reevaluation
TECHNIQUE
Patient Preparation
Caretaker/parent holds child in her/his lap, restraining the unaffected arm
Hyperpronation Method (FIGURE 92.1B)
With one hand, encircle the elbow with the thumb over the region of the radial head, keeping the elbow flexed at 90 degrees
With the other hand, grasp the wrist, and firmly pronate at the wrist
Supination/Flexion Method (FIGURE 92.1C and D)
With one hand, encircle the elbow with the thumb over the region of the radial head, keeping the elbow position in some flexion
With the other hand, grasp the wrist and apply gentle traction before supination
In one motion, supinate the forearm fully and flex the elbow to the ipsilateral shoulder
Postprocedure
Reevaluate child in 10 to 15 minutes to note use of arm. The child will generally regain use of the arm quickly.
If the child has not regained use of the arm within 10 to 15 minutes of attempted reduction and no click was detected during procedure, the procedure should be repeated
Radiography should be performed if the child has not regained use of arm after a reasonable time and no click was detected