injuries poisoning
Radial Head Subluxations
Treatment of Radial Head Subluxations
Reduction Reduction may be done using Supination-flexion Hyperpronation Neither technique requires sedation or analgesia; the child experiences pain only for a few seconds. Hyperpronation has a higher first-attempt success rate ( Treatment reference ). (See also Insupination-flexion,the elbow is completely extended and supinated, then flexed. A subtle palpable pop or click is often detected when the radial head resumes its normal position. Inhyperpronation,the practitioner supports the child's arm at the elbow and places moderate pressure with a finger on the radial head. The practitioner then grips the distal forearm with the other hand and hyperpronates the forearm. A pop can be felt at the radial head when it is reduced. Children usually start to move the elbow after about 10 to 20 minutes. If they do not move it, x-rays of the elbow should be taken. If they do move it, x-rays and immobilization are unnecessary. If pain or dysfunction lasts>24 hours, incomplete reduction or an occult fracture should be suspected. Radial head subluxation recurs in 20 to 40% of children. 1.Bek D, Yildiz C, Köse O, et al: Pronation versus supination maneuvers for the reduction of 'pulled elbow': A randomized clinical trial.Eur J Emerg Med16 (3):135–138, 2009. doi: 10.1097/MEJ.0b013e32831d796a 