Ultrasound findings of the elbow posterior fat pad in children with radial head subluxation

TY - JOUR

T1 - Ultrasound findings of the elbow posterior fat pad in children with radial head subluxation

AU - Rabiner, Joni E.

AU - Khine, Hnin

AU - Avner, Jeffrey R.

AU - Tsung, James W.

N1 - Publisher Copyright: Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2015/5/15

Y1 - 2015/5/15

N2 - Objective: The aim of this study was to determine whether elbow ultrasound findings of the posterior fat pad (PFP) are present in patients with diagnosis of radial head subluxation (RHS). Methods: This was a prospective study of children presenting to an urban pediatric emergency department diagnosed clinically with RHS. Physicians received a 1-hour training session on musculoskeletal ultrasound including the elbow. Before performing reduction for RHS, the physicians performed a brief, point-of-care elbow ultrasound using a high-frequency linear transducer probe in both longitudinal and transverse views to evaluate for PFP elevation and lipohemarthrosis (LH). Successful clinical reduction with spontaneous movement of injured extremity served as the criterion standard for RHS. Clinical telephone follow-up was performed to ascertain outcomes. Results: Forty-two patients were enrolled with a mean age of 22.3 (11.8) months. The mean time to presentation was 7 (9.2) hours, and 9/42 (21%) children had previous history of RHS. The majority of patients (35/42, 83%; 95% confidence interval (CI), 69%-92%) had a normal elbow ultrasound. Of 42 patients, 6 (14%; 95% CI 6%-28%) had an elevated PFP and 2 (5%; 95% CI, 0.5%-17%) had LH. Clinical reduction was successful in 100% of patients, and there were no complications reported on follow-up. Conclusions: The majority of children with RHS have a normal PFP on elbow ultrasound, but elevated PFP and LH are possible findings. Reduction maneuvers for RHS may be attempted in patients with a normal elbow ultrasound when the diagnosis of RHS or elbow fracture is uncertain.

AB - Objective: The aim of this study was to determine whether elbow ultrasound findings of the posterior fat pad (PFP) are present in patients with diagnosis of radial head subluxation (RHS). Methods: This was a prospective study of children presenting to an urban pediatric emergency department diagnosed clinically with RHS. Physicians received a 1-hour training session on musculoskeletal ultrasound including the elbow. Before performing reduction for RHS, the physicians performed a brief, point-of-care elbow ultrasound using a high-frequency linear transducer probe in both longitudinal and transverse views to evaluate for PFP elevation and lipohemarthrosis (LH). Successful clinical reduction with spontaneous movement of injured extremity served as the criterion standard for RHS. Clinical telephone follow-up was performed to ascertain outcomes. Results: Forty-two patients were enrolled with a mean age of 22.3 (11.8) months. The mean time to presentation was 7 (9.2) hours, and 9/42 (21%) children had previous history of RHS. The majority of patients (35/42, 83%; 95% confidence interval (CI), 69%-92%) had a normal elbow ultrasound. Of 42 patients, 6 (14%; 95% CI 6%-28%) had an elevated PFP and 2 (5%; 95% CI, 0.5%-17%) had LH. Clinical reduction was successful in 100% of patients, and there were no complications reported on follow-up. Conclusions: The majority of children with RHS have a normal PFP on elbow ultrasound, but elevated PFP and LH are possible findings. Reduction maneuvers for RHS may be attempted in patients with a normal elbow ultrasound when the diagnosis of RHS or elbow fracture is uncertain.

KW - Elbow trauma

KW - Radial head subluxation

KW - Ultrasonography

UR - https://www.scopus.com/pages/publications/84929255140

U2 - 10.1097/PEC.0000000000000420

DO - 10.1097/PEC.0000000000000420

M3 - Article

C2 - 25875991

AN - SCOPUS:84929255140

SN - 0749-5161

VL - 31

SP - 327

EP - 330

JO - Pediatric Emergency Care

JF - Pediatric Emergency Care

IS - 5

ER -