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Traumatic radial head subluxation in young children: a case report and literature review
Insights
Traumatic radial head subluxation in children, often missed, results from forearm injury. This review details two types and their diagnosis using X-rays, aiding in prompt treatment.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Pediatric Traumatology
Background:
- Traumatic radial head subluxation is a common pediatric elbow injury, frequently resulting from longitudinal traction on a pronated and extended forearm.
- This condition is often underdiagnosed due to subtle presentation and lack of awareness among clinicians.
Observation:
- The study reviews the differential diagnosis of traumatic radial head subluxation, distinguishing it from dislocation, congenital abnormalities, brachial plexus palsy, and occult fractures.
- Two distinct types of traumatic rotary radial head subluxation in pronation are proposed: the simple type and the lateral type.
Findings:
- Radiographic analysis, specifically anteroposterior elbow views, can identify the simple type by changes in the radial tuberosity's shape and position.
- The lateral type is characterized by lateral displacement of the radial head relative to the ulna, identifiable on X-rays.
Implications:
- Accurate radiographic assessment is crucial for differentiating between simple and lateral types of radial head subluxation.
- Understanding these classifications aids in appropriate management, with successful supination manipulative reduction demonstrated for the lateral type.
Abstract:
Traumatic radial head subluxation in young children is reviewed. This minor condition commonly results from a sudden longitudinal traumatic pull on pronated and extended forearm and appears to be infrequently recognized or diagnosed. Differential diagnosis of traumatic radial head subluxation from traumatic radial head dislocation, congenital radial head dislocation, brachial plexus palsy and "invisible" elbow fractures are discussed. It is postulated here that there are two types of traumatic rotary radial head subluxation in pronation, the simple type and the lateral type. Careful analysis of anteroposterior view of elbow reveals the change of the shape and position of the radial tuberosity indicating the simple type, or concommitant with lateral displacement of the radial head on the ulna indicating the lateral type. The lateral type and its reposition are demonstrated when premanipulative roentgenograms are compared with postmanipulative roentgenograms in one of the eight illustrative cases. Details of the supination manipulative reduction are described and demonstrated.