Prospective study of recurrent radial head subluxation
S. J. Teach and S. A. Schutzman
Division of Emergency Medicine, Children's Hospital of Buffalo, NY, USA.
OBJECTIVES: To calculate a recurrence rate for radial head subluxation
(RHS) and to identify risk factors for recurrence. DESIGN: Prospective
cohort study. SETTING: Pediatric emergency department of an urban, tertiary
care children's hospital. PATIENTS: Consecutive sample of 107 children
younger than 6 years with definite (n = 94) or probable (n = 13) RHS
enrolled during a 6-month period and followed up for at least 12 months.
MAIN OUTCOME MEASURE: Recurrent episodes of RHS. RESULTS: Follow-up
information was available on 86.9% (93/107) patients, with a mean +/- SD of
16.4 +/- 1.9 months (range, 12 to 20 months). Of these 93 patients, 22
(23.7%) had recurrent RHS. Among the patients who had their first episode
of RHS during the study period (n = 76), those with recurrences were
significantly younger than those without (21.7 +/- 9.9 months vs 29.2 +/-
13.5 months, respectively, P = .04, t test). Those 24 months or younger had
a relative risk of 2.60 for one or more recurrences during the study period
(95% confidence interval, 1.04 to 6.30) compared with those older than 24
months. No differences were observed in duration of follow-up, sex, elbow
involved in the initial episode, or family history of RHS between those
with and without recurrences. CONCLUSIONS: Recurrent RHS occurs in nearly
one fourth of patients, and those 24 months or younger are at greatest
risk. Sex, family history, and the elbow involved in the initial episode
are not risk factors for recurrence.
