Nursemaid's Elbow (Subluxation of the Radial Head) Reduction (Pediatrics)

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  • Reduction should be attempted if a subluxation of the radial head is suspected and the diagnosis of fracture is excluded.
  • A history of a fall should raise concern over the diagnosis, and evaluation for alternative diagnoses, such as fracture, should be done.
  • Plain radiographs of the elbow should be considered in the following circumstances:
    • The history is not consistent with a pulling mechanism (e.g., history of a fall).
    • The patient has pain while still.
    • Any swelling, ecchymosis, or point tenderness of the elbow is noted.
  • Any child with a suspected fracture should not undergo reduction of a suspected subluxed radial head.
  • None
  • The radial head is held in position against the capitellum by the annular ligament.
  • Axial traction on the arm may cause the annular ligament to slip over the head of the radius and into the radiohumeral joint.

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  • Leave the patient for 10 to 15 minutes to allow the child time to start using the arm.
  • If the reduction is successful, the patient should be able to use the arm normally.
  • Analgesia and/or immobilization are not required, except in very rare cases.
  • In patients with a fracture, attempted reduction of a possible nursemaid's elbow may result in fracture displacement and neurovascular compromise.
  • Reduction may be unsuccessful: sling and/or posterior splint with follow-up in 24 to 48 hours.
  • Although not a complication of the procedure, subluxation may recur, particularly in children less than 2 years of age.
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