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Factors Associated with Radiologic Tests in Patients with Radial Head Subluxation  

Chang, Ikwan (Department of Emergency Medicine, Seoul National University College of Medicine)
Kim, Do Kyun (Department of Emergency Medicine, Seoul National University College of Medicine)
Park, So Young (Department of Emergency Medicine, Seoul National University College of Medicine)
Suh, Dongbum (Department of Emergency Medicine, Seoul National University College of Medicine)
Jung, Jae Yun (Department of Emergency Medicine, Seoul National University College of Medicine)
Kwak, Young Ho (Department of Emergency Medicine, Seoul National University College of Medicine)
Publication Information
Journal of Trauma and Injury / v.27, no.2, 2014 , pp. 13-19 More about this Journal
Abstract
Purpose: In general, X-ray examinations are not recommended for radial head subluxation (pulled elbow) patients. The purpose of this study was to determine the frequency of X-ray examinations and to investigate the factors associated with the decision to perform an X-ray examination on a patient with a pulled elbow. Methods: Patients who visited the pediatric emergency department (ED) of one tertiary hospital from January 1, 2011, to December 31, 2012, with a diagnosis of radial head subluxation at discharge were enrolled in this study. Through retrospective chart reviews, factors that could have influenced the decision to perform an X-ray examination and their statistical relevance were analyzed. Results: A total 308 patients were enrolled, and 101 patients (32.8%) underwent X-ray examinations. Among the 252 patients with a typical pulled elbow, 65 underwent X-ray examination. This result showed statistical significance compared to atypical pull-elbow group (25.8% vs. 64.3%, p<0.001). Factors associated with the decision to perform an X-ray examination were analyzed using the Chi-square test and the Fisher's exact test. The mechanism of injury and consultation with an orthopedic surgeon (p=0.001) showed statistical significance. In the multivariable logistic regression, the odds ratio (OR) for the injury mechanism was 4.7 (95% CI: 1.8~8.8, p<0.001) and that for consultation with an orthopedic surgeon was 8.0 (95% CI: 1.6~40.7, p=0.004). Conclusion: One third of patients with a pulled elbow underwent X-ray examination, and patients with an atypical mechanism of injury underwent more frequent X-ray examinations than did patients with a typical mechanism of injury. The factors that could have influenced the decision to perform an X-ray examination were mechanism of injury and consultation with an orthopedic surgeon.
Keywords
Radius; X-ray; Child;
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Times Cited By KSCI : 1  (Citation Analysis)
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1 Broomfield D.J., Maconochie I. The pulled elbow: a review article. Trauma 2004; 6: 255-9.   DOI
2 Schutzman SA. Teach S. Upper-extremity impairment in young children. Ann Emerg Med 1995: 26; 474-9.   DOI
3 JI Lee, JY Ryu, JY You. A comparison of two methods in the reduction of radial head subluxations. J Korean Soc Emerg Med 2004; 15: 325-30.
4 Choung walter, Heinrich, Stephen D. J Acute annular ligament interposition into radiocapitellar joint in children (nursemaid's elbow). Pediatr Orthop 1995; 15: 454-6.   DOI
5 Sacchetti A, Ramoska EE, Glascow C. Nonclassic history in children with radial head subluxations. J Emerg Med 1990; 8: 151-3.   DOI
6 Salter RB, Zaltz C. Anatomic investigation of the mechanism of injury and pathologic anatomy of "Pulled elbow" in young children. Clin Orthop 1971; 77: 134-43.
7 Illingworth C.M. Pulled elbow: a study of 100 patients. BMJ 1975; 2: 672-4.   DOI
8 The korean society of emergency medicine. Emergency Medicine 1st ed. Seoul: KoonJa; 2011. p.1236.
9 Quan L, Marcuse EK. The epidemiology and treatment of radial head subluxation. Am J Dis Child 1985; 139: 1194-7.
10 Schunk JE. Radial head subluxation: epidemiology and treatment of 87 episodes. Ann Emerg Med 1990; 19: 1019-23.   DOI
11 John AM, Robert SH, Ron MW. Rosen's Emergency Medicine. Concepts and Clinical Practice. 7th ed. Philadelphia: Mosby Elsevier; 2010. p.2254.
12 Tintinalli JE, Kelen GD, Stapczynski. Emergency Medicine. A comprehensive study guide. 7th ed. New York: McGraw-Hill; 2011. p.983.