Missed elbow fractures misdiagnosed as radial head subluxations

Over a 36-month period, 11 children were treated in our department for fractures about the elbow which initially went undiagnosed, as they had first undergone reduction maneuvers for a suspected radial head subluxation, without prior imaging. The most frequent final diagnosis was supracondylar humerus fracture (n = 4). A fall was reported for six children (54.5%); the mechanism of injury remained unknown in four children (36.4%). In four of eleven children (36.4%) there was moderate or major soft tissue swelling at the time of first presentation, which is uncommon in radial head subluxation. Reduction of a suspected radial head subluxation without any prior radiological investigation can be recommended exclusively when the typical history of an abrupt traction by an (adult) attending person is positively reported. In every other case, radiographs should be done prior to any attempt at reduction.