Did you check your nursemaid's elbow?

Reconsidering the "Classic" Clinical History Associated with Subluxations of the Radial Head

Introduction

The national burden of radial head subluxations in the United States (U.S.) population is poorly defined, and non-classical injury mechanisms have been increasingly reported in recent years. The purpose of this study is to report historical national estimates and demographic characteristics of patients presenting to U.S. emergency departments (ED) with subluxations of the radial head.

Methods

This cross-sectional, retrospective study analyzes the National Electronic Injury Surveillance System (NEISS) database (2001–2017) to identify patients ≤ 7 years of age presenting to U.S. EDs with subluxations of the radial head.

Results

Linear regression (R2 = 0.65; P < 0.01) demonstrated that the annual number of patients presenting to U.S. EDs with subluxations of the radial head increased significantly (P < 0.001) between 2001 (N=13,247; confidence interval [CI], 9,492–17,001) and 2010 (N=21,723; CI, 18,762–24,685), but did not change significantly between 2010 and 2017 (R2 < 0.01; P = 0.85). It also demonstrated that 51.0% (CI, 45.3%–56.6%) of injuries were either self-induced or spontaneous, whereas 36.8% (CI, 31.6%–42.0%) and 9.4% (CI, 8.0%–10.7%) were associated with parents/guardians or siblings, respectively. The majority of injuries occurred in patients who were the age of one (33.5%; CI, 32.1%–35.0%) and two (35.1%; CI, 33.7%–36.6%); females (57.8%; CI, 56.8%–58.9%) were more commonly injured than males.

Conclusion

Although the national burden of radial head subluxations may be less than previously reported, it still results in over 20,000 ED visits annually in the U.S. Given that over half of such injuries are actually self-induced or spontaneous, caretakers should be taught to recognize the clinical presentation of radial head subluxation, since the classically described history of a patient being lifted or pulled by the arm may simply have never occurred.