Wong Kei, Troncoso Alex B, Calello Diane P, Salo David, Fiesseler Fred
Department of Pediatrics, Morristown Medical Center, Morristown, New Jersey.
Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.
J Emerg Med. 2016 Dec;51(6):621-627. doi: 10.1016/j.jemermed.2016.07.081. Epub 2016 Sep 27.
Radial head subluxation (RHS) is a common complaint seen in the pediatric emergency department in children ages 6 months to 4 years. Classically, injury occurs due to axial traction on the arm, but this mechanism is not universal. Some patients will have recurrent RHS; some may undergo x-ray (XR) evaluation for alternative diagnosis.
To determine factors associated with recurrences and radiographic evaluations in RHS.
A retrospective study with inclusion criteria: under 10 years of age with discharge diagnosis "nursemaid," "radial head," or "subluxation." We examined factors associated with RHS recurrences, circumstances when radiographic evaluations performed, physician's training background (pediatric vs. general emergency medicine), mechanisms of injury, and demographic factors including age, gender, and arm involved.
In 246 visits, median age was 27 months (interquartile range 16.1), with females comprising 55.7% (n = 137), and left-sided predominance (52%, n = 130). Mechanisms of injury were classified as "pull" (65.9%, n = 162), "non-pull" (15.9%, n = 39), and "unknown" (18.3%, n = 45). Eighteen patients with recurring RHS were more likely to be male (p = 0.008). In 61 visits where radiography was performed, patients were older (p = 0.03), with a higher frequency seen in non-pull and unknown mechanism (p = 0.0001). No significant difference was found in frequency of radiographs obtained in regard to physician training (p = 0.4660).
RHS can result from a myriad of mechanisms. We found that recurrence was more likely in male patients. Factors associated with radiographic evaluation included atypical mechanism, older age, and unclear history, regardless of physician training background.
桡骨头半脱位（RHS）是儿科急诊科6个月至4岁儿童中常见的病症。传统上，损伤是由于手臂受到轴向牵引所致，但这种机制并非普遍存在。一些患者会反复发生RHS；一些患者可能会接受X线（XR）检查以进行鉴别诊断。
确定与RHS复发及影像学评估相关的因素。
一项回顾性研究，纳入标准为：年龄在10岁以下，出院诊断为“保姆肘”“桡骨头”或“半脱位”。我们研究了与RHS复发相关的因素、进行影像学评估的情况、医生的培训背景（儿科与普通急诊医学）、损伤机制以及人口统计学因素，包括年龄、性别和受累手臂。
在246次就诊中，中位年龄为27个月（四分位间距16.1），女性占55.7%（n = 137），左侧占优势（52%，n = 130）。损伤机制分为“牵拉”（65.9%，n = 162）、“非牵拉”（15.9%，n = 39）和“不明”（18.3%，n = 45）。18例反复发生RHS的患者更可能为男性（p = 0.008）。在61次进行了放射检查的就诊中，患者年龄较大（p = 0.03），在非牵拉和不明机制中出现频率较高（p = 0.0001）。就医生培训而言，获得放射照片的频率无显著差异（p = 0.4660）。
RHS可由多种机制引起。我们发现男性患者更易复发。与影像学评估相关的因素包括非典型机制、年龄较大和病史不明，与医生的培训背景无关。
