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Radiographic changes with radial head subluxation in children
1Department of Emergency Medicine, Albany Medical Center Hospital, NY 12208.
Insights
Radial head subluxation (RHS) in children may show radiocapitellar line (RCL) displacement on X-rays. This finding confirms RHS but doesn't alter treatment or outcomes.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Emergency Medicine
Background:
- Radial head subluxation (RHS) is typically diagnosed without radiographic abnormalities.
- Recent reports suggest radiocapitellar line (RCL) displacement may indicate RHS in pediatric patients.
Purpose of the Study:
- To retrospectively investigate the presence and significance of RCL displacement in pediatric patients diagnosed with RHS.
Main Methods:
- Review of elbow and forearm radiographs from pediatric patients under 5 years old diagnosed with RHS.
- Analysis of RCL displacement measurements on 20 identified RHS cases.
Main Results:
- Five out of 20 (25%) radiographs showed RCL displacement greater than 3 mm, indicating RHS.
- Normal radiographs had RCL displacement less than or equal to 3 mm.
- RCL displacement confirmed RHS but did not impact treatment or outcomes.
Conclusions:
- RCL displacement is a radiographic indicator of RHS in young children.
- Radiographs may not always be necessary for confirmed RHS diagnoses.
- X-rays are recommended for atypical presentations or unsuccessful reductions to rule out severe injuries.
Abstract:
Radial head subluxation (RHS) produces no radiographic abnormalities according to most experts. However, recent anecdotal case reports have identified displacement of the radiocapitellar line (RCL) in pediatric patients with RHS. To verify this finding, we retrospectively reviewed all patients less than 5 years of age who received elbow and forearm radiographs in our emergency department. From January 1988 through April 1989, we identified 20 cases of RHS. Of the 20 radiographs, 5 (25%) were read by the attending radiologist as abnormal due to RCL displacement indicating subluxation of the radiocapitellar articulation. All 5 of these radiographs had RCL displacement greater than 3 mm. The remaining normal radiographs had RCL displacement less than or equal to 3 mm. The presence of RCL displacement without disruption of the radiocapitellar articulation confirms the diagnosis of RHS, but does not appear to change treatment or outcome in this subset of patients. In addition, radiographs may not be mandatory when the diagnosis of RHS is certain. We suggest obtaining radiographs if the history (i.e., fall) or physical examination is atypical or if reduction is unsuccessful to rule out more serious injuries such as radial head dislocation or fracture.