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Ultrasonido musculoesqueletico de codo en un niño con subluxación radial / Elbow MSK ultrasound in children with radial subluxation

#Elbow MSK ultrasound  #radial subluxation

Este artículo es originalmente publicado en:
Rabiner JE1, Khine H, Avner JR, Tsung JW.
Pediatr Emerg Care. 2015 May;31(5):327-30. doi: 10.1097/PEC.0000000000000420.
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Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Lippincott Williams & Wilkins



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).


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.


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 elbowultrasound. 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.


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.




[PubMed – in process]

Elbow MSK ultrasound in children with radial subluxation

In radial head subluxations (RHS), which is one of the most common elbow injuries in children, the annular ligament slips into the radiohumeral articular space. History taking and physical examination are often not sufficient to differentiate RHS from elbow fractures. However, MSK ultrasound provides the possibility to detect an elevated posterior fat pad (PFP) or lipohemarthrosis of the PFP, findings that are highly sensitive for fracture at the elbow. It is not clear though whether the same findings are also present in children with RHS. 
Therefore, this study has the aim to determine the MSK ultrasound findings of the elbow PFP in children with RHS.
The authors found that in the majority of children with RHS (83%), the MSK ultrasound findings were normal. Only 17 % of the children tested had a minimally elevated elbow PFP. Thus, elevated elbow PFP and lipohemarthrosis can be possible findings in children with RHS, but normal MSK ultrasound findings may encourage the clinician’s choice for reduction of the RHS. The use of MSK ultrasound might consequently also decrease the number of unnecessary radiographs.
> From: Rabiner et al., Pediatr Emerg Care 31 (2015) 1-5. All rights reserved to Wolters Kluwer Health, Inc. Click here for the Pubmed summary.
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