Current views on radial head subluxation

Abstract

Backgrоund. Radial head subluxation is the most common injury in young children and accounts for 2.6% of the total population in this age group. In 39%-82% of cases, the mechanism of injury is the traction of the arm, but subluxation can occur during a fall and in other circumstances; in 19%-51% of cases, the mechanism of injury is unknown. Aim. The purpose of this study is to generalize and arrange the available literature and data and present current views on the prevalence, etiology, pathogenesis, diagnosis, and treatment of radial head subluxation in children. Materials and methods. A literature search was performed using the PubMed, PubMed Central, Google Scholar, CNKI-Scholar, Cyberleninka, and eLibrary databases. The sample of sources was mainly limited to 2000-2019. Results. The cause of subluxation is the displacement of the annular ligament and its interposition in the humeroradial joint. It is determined by a number of features of the elbow joint anatomy in young children. Diagnosis of radial head subluxation is based on history and clinical data; radiography and ultrasonography are used to obtain a clear clinical picture and to exclude fractures. The mainstay of treatment is a closed reduction, which is conducted via two methods as follows: Supination-flexion and hyperpronation. According to modern research data, preference is given to the hyperpronation method; it is more effective in terms of number of reduction attempts, is technically simpler and, possibly, less painful. Generally, immobilization after effective reduction is not required as the function of the elbow joint is fully restored. A consequence of radial head subluxation is recurrence, which occurs in 5%-46% of cases. A factor associated with recurrence is being less than two years of age. The prophylaxis of radial head subluxation is aimed at preventing forceful arm traction in children under three years of age and involves educating the parents or caregivers in the symptoms of subluxation to prevent late admission. Conclusions. Radial head subluxation is found in young children and is mainly diagnosed clinically. The treatment consists of a closed reposition, and the prognosis for restoring limb function is favorable.