What is included in postprocedural care of a radial head subluxation?

Updated: Apr 08, 2020
  • Author: Gretchen S Lent, MD; Chief Editor: Erik D Schraga, MD  more...
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Once the radial head has been reduced, the child’s pain and apprehension often immediately resolve. The practitioner should leave the patient’s bedside immediately after the procedure and return to reevaluate in 10 minutes. Most children begin to use the affected arm immediately, though some may take as long as 30 minutes to start doing so (see the image below). [20] The time from reduction to normal arm use is increased in younger patients and those whose subluxations have been present for more than 12 hours.

Shortly after reduction, child resumes using affec Shortly after reduction, child resumes using affected arm.

If the first attempt at reduction proves unsuccessful, further attempts can be made (~15 minutes apart); however, alternative diagnoses should be considered after multiple failed attempts. If the child does not begin using the arm normally after such attempts, a radiograph should be obtained to look for fractures or other complications. [21] When multiple reduction attempts prove unsuccessful, a sling or posterior long arm splint may be applied for comfort, and the child can be referred to an orthopedist.

Although a 24-hour sling may be placed on the elbow for comfort, this measure is not necessary for most patients. Occasionally, symptoms may last for several days, and a sling may be worn for longer.

Ultrasonography can be used to evaluate subluxations and determine the success of reduction. Furthermore, it can be used to confirm the healing of the annular ligament after treatment in complex cases. [22]

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