Management and Outcomes of Children With Nursemaid’s Elbow

Genadry, Katia C.; Monuteaux, Michael C.; Neuman, Mark I.; Lipsett, Susan C.

doi:10.1016/j.annemergmed.2020.09.002

Cited by 8 publications

(13 citation statements)

References 14 publications

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“…Further injuries were joint dislocations with the nursemaids elbow being the most common one with the highest prevalence at the age between 1 and 3 years. Similar to previous studies, female predominance was found with a ratio of 1.76:1 [ 30 , 31 ]. Second most common dislocation was the patella dislocation.…”

Section: Discussionsupporting

confidence: 90%

Epidemiology, patterns, and mechanisms of pediatric trauma: a review of 12,508 patients

Cintean

Eickhoff

Zieger

et al. 2022

Eur J Trauma Emerg Surg

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Background Pediatric traumas are common and remain a unique challenge for trauma surgeons. Demographic data provide a crucial source of information to better understand mechanisms and patterns of injury. The aim of this study was to provide this information to improve treatment strategies of potentially preventable morbidity and mortality in children. Material and methods A retrospective review of every pediatric trauma treated in the emergency department (ED) between 2015 and 2019 was performed. Inclusion criteria were the age between 0 and 14 years and admission to the ED after trauma. Demographic data, time of presentation, mechanism of injury and pattern of injury, treatment, and outcome were analyzed. Different injury patterns were assessed in relation to age group, sex, mechanism of injury and treatment. Results A total of 12,508 patients were included in this study. All patients were stratified into five age groups: babies under the age of 1 (8.8%), toddlers between 1 and 3 (16.8%), preschool children between 4 and 6 (19.3%), young school children between 7 and 10 (27.1%), and young adolescents between 11 and 14 (27.9%). The predominant sex in all age groups was male. 47.7% of patients were admitted between 4 and 10 pm; 14.8% of the patients arrived between 10 pm and 8 am. Peak months of admissions were May to July. Overall, 2703 fractures, 2924 lacerations and superficial tissue injury, 5151 bruises, 320 joint dislocations, 1284 distortions, 76 burns, and 50 other injuries were treated. Most common mechanisms for fractures were leisure activities, falls, and sports-related activities. Forearm fractures were the most common fractures (39.5%) followed by humerus fractures (14%) and fractures of the hand (12.5%). A total of 700 patients with fractures (25.9%) needed surgery. 8.8% of all patients were hospitalized for at least one day. 4 patients died in the hospital (0.03%). Conclusion Despite of higher risk, severe injuries in children are rare. Minor injuries and single fractures are common. Treatment should be managed in specialized centers to ensure an interdisciplinary care and fast recovery. Peak times in the late afternoon and evening and summer months should be taken into consideration of personnel planning.

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Section: Discussionsupporting

confidence: 90%

Epidemiology, patterns, and mechanisms of pediatric trauma: a review of 12,508 patients

Cintean

Eickhoff

Zieger

et al. 2022

Eur J Trauma Emerg Surg

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“…Radiographs of nursemaid's elbow patients are typically normal (10) . According to Genadry et al (3) , more efforts should be directed to reducing unnecessary radiography in pulled elbow patients. In their study, radiographs were done to more than a quarter of nursemaid elbow patients, and missed fractures were rare.…”

Section: Discussionmentioning

confidence: 99%

“…It commonly affects children aged between 1 and 4 years old. The highest incidence of this injury is among children aged two and three years (2,3) . It is classically caused by axial traction on the extended arm while the forearm is in a pronated position, causing the radial head to be slipped under the annular ligament (1,4) .…”

Section: Introductionmentioning

confidence: 99%

Atypical Presentation of Nursemaid's Elbow: A Case Report

Mohamed¹,

Ali²,

Nawaz³

2023

The Egyptian Journal of Hospital Medicine

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Background: Nursemaid's elbow is a known orthopedic pediatric emergency that occurs between one and four years of age. Axial traction of the extended arm when the forearm is pronated is the most frequently reported mechanism of infliction. However, other mechanisms are mentioned in the literature. Cases report: We report a case of pulled elbow in a four-month-old child. The mother reported that the child only rolled over to her side. Conclusion: A high index of suspicion for pulled elbow should be kept in younger infants despite the absence of the usual presentation.

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“…Genadry et al 7 reported acquisition of radiographs for 28.5% of patients with pulled elbow, yet only 0.3% of patients with radiographs actually had a fracture. Similarly, Irie et al 13 found 6 of 2331 patients (0.2%) who had a fracture and were misdiagnosed as having a pulled elbow.…”

Section: Discussionmentioning

confidence: 99%

Overutilization of Radiographs for Pulled Elbow Among Orthopedic Surgeons Compared With Pediatricians

et al. 2022

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BackgroundPulled elbow is a common pediatric condition, treated by pediatricians and orthopedic surgeons. The diagnosis is clinical, and imaging is only required where an occult fracture is suspected, although overuse is reported. In this study, we explore the epidemiology of pulled elbow in Israel, focusing on the differences in management between physicians of various specialties.MethodsElectronic medical records of the largest health provider in Israel, which provides health services to more than 50% of the population, were reviewed for pulled elbow cases between 2005 and 2020. Patients aged 4.5 months to 7 years were included. Demographic information, the discipline of the treating physician, and acquisition of elbow radiographs were gathered.ResultsA total of 4357 patients, 62.8% girls, were included. The average body mass index was 16.1 (SD, 1.2). Most patients were from communities in the upper half of the socioeconomic status clusters 6 to 10 (64.63%). Most patients were attended by a pediatrician (51.5%), followed by an orthopedic surgeon (19.9%). Radiographs were acquired for 570 children (13.1%). Most radiographs (36.5%) were requested by orthopedic surgeons and for children in the boundary age groups. The patient's socioeconomic status was associated with access to physicians of different subspecialties, and lower income families had a higher tendency to be treated by nonspecialized physician (P < 0.001).ConclusionsOrthopedic surgeons use elbow radiographs much more than pediatricians; effort should aim at reducing the imaging rate for this population.

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Management and Outcomes of Children With Nursemaid’s Elbow

Cited by 8 publications

References 14 publications

Epidemiology, patterns, and mechanisms of pediatric trauma: a review of 12,508 patients

Epidemiology, patterns, and mechanisms of pediatric trauma: a review of 12,508 patients

Atypical Presentation of Nursemaid's Elbow: A Case Report

Overutilization of Radiographs for Pulled Elbow Among Orthopedic Surgeons Compared With Pediatricians

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