Nonclassic history in children with radial head subluxations

Radial head subluxation (RHS) is a common pediatric orthopedic injury, frequently diagnosed through the classic history of axial traction to the upper extremity of a child. However, not all children with RHS will present with this classic history. This may result in misdiagnosis and delay of appropriate treatment. To evaluate the prevalence of non-classic presentations, a retrospective study was conducted of 45 emergency department patients with RHS. Of these patients, 15 presented with an atypical history. All patients were in minimal distress, holding their affected arms semiflexed and pronated (the nursemaid's position). The classic and nonclassic history groups were equivalent in patient age, spontaneous reductions, and physician reductions. A trend towards more radiographs was noted in the nonclassic group. This study suggests that even in the absence of the classic history of upper extremity traction, radial head subluxation should be suspected in any pediatric patient with an upper extremity complaint who presents with the affected arm in the nursemaid's position.