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Published on: October 5, 2018
Suspected Radial Head Subluxation in Infants: The Need for Radiologic Evaluation
Insights
Radial head subluxation is common in toddlers but rare in infants. A case series found forearm fractures misdiagnosed as pulled elbow in nonambulatory infants, highlighting the need for X-rays in this population.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Child Abuse Detection
Background:
- Radial head subluxation (pulled elbow) is a frequent pediatric injury in ambulatory children aged 1-4 years.
- Diagnosis is typically clinical, often foregoing imaging like X-rays.
- It is considered an uncommon condition in nonambulatory infants.
Observation:
- A case series identified two nonambulatory infants with forearm fractures initially misdiagnosed as radial head subluxation.
- These infants presented with injuries inconsistent with typical pulled elbow presentations.
- The fractures required prompt recognition and appropriate management.
Findings:
- The clinical diagnosis of radial head subluxation is unreliable in nonambulatory infants.
- Forearm fractures can be mistaken for radial head subluxation in this age group.
- X-ray imaging is crucial for accurate diagnosis in nonambulatory infants presenting with suspected elbow injuries.
Implications:
- Current guidelines for imaging prior to pulled elbow reduction should be extended to all nonambulatory infants.
- Early X-ray use in nonambulatory infants can prevent misdiagnosis and ensure timely treatment.
- This approach aids in the crucial early identification of potential non-accidental trauma or abuse in infants.
Abstract:
Radial head subluxation ("pulled elbow" or "nursemaid's elbow") is a common pediatric condition in children aged 1 to 4 years, although it is an uncommon finding in nonambulatory infants. It is a clinical diagnosis, and further investigations such as x-ray are not routinely done. We present a case series of 2 nonambulatory infants with forearm fractures that were initially diagnosed as radial head subluxation. Current literature supports the use of x-ray in children with atypical or unclear history prior to an attempted pulled elbow reduction. We suggest that this recommendation should be extended to all nonambulatory infants, given the unlikely diagnosis of radial head subluxation, and the necessity for early recognition of injuries that may be indicators of abuse.
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