Point-of-Care Ultrasonography to Assist in the Diagnosis and Management of Subluxation of the Radial Head in Pediatric Patients: A Case Series

J Emerg Med. 2017 May;52(5):702-706. doi: 10.1016/j.jemermed.2017.01.049. Epub 2017 Mar 9.

Abstract

Background: A subluxation of the radial head (SRH) is a clinical condition that commonly occurs in children under 6 years of age. History and physical examination findings typically include a child who presents with an elbow held in extension and with forearm pronation, after having suffered significant longitudinal traction on the arm, or after a fall on an outstretched hand. The diagnosis is often clinically obvious. The injury responds dramatically to closed reduction, and usually no imaging is required. However, cases with atypical presentations and patients who do not respond favorably to a reduction maneuver present clinical challenges, because the initial diagnosis of SRH may seem to be questionable or erroneous. Point-of-care ultrasound (POCUS) can assist decision-making and clinical management for these patients.

Case reports: We report three cases of SRH that were diagnosed and managed with POCUS in the emergency department. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS can assist in the diagnosis and management of patients with clinical suspicion of SRH, especially in cases of atypical presentations or cases in which the mechanism of injury is unknown. It is also an extremely valuable tool in determining postprocedure reduction success.

Keywords: emergency department; hook sign; point-of-care ultrasound; subluxation of the radial head.

MeSH terms

  • Bone Malalignment / diagnosis*
  • Bone Malalignment / therapy
  • Child, Preschool
  • Disease Management*
  • Emergency Service, Hospital / organization & administration
  • Female
  • Humans
  • Infant
  • Male
  • Pediatrics / methods
  • Point-of-Care Systems / standards
  • Radius / abnormalities*
  • Radius / injuries
  • Ultrasonography / methods*

Supplementary concepts

  • Radial Heads, Posterior Dislocation Of