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La subluxation de la tête radiale ou « pronation douloureuse »

Radial head subluxation or “nursemaid’s elbow”

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Annales françaises de médecine d'urgence

Résumé

La subluxation de la tête radiale, aussi dénommée « pronation douloureuse », est secondaire à une interposition du ligament annulaire au sein de l’articulation huméroradiale. Il s’agit d’une pathologie ostéoarticulaire pédiatrique fréquente en service d’urgences. Elle nécessite une réduction spécifique qui consiste à lever l’interposition ligamentaire. Les deux principales techniques de réduction sont la manoeuvre classique combinant un mouvement de supination et de flexion de l’avant-bras et une manoeuvre, moins connue, consistant à réaliser une pronation forcée jusqu’à la perception d’un ressaut au niveau de la tête radiale signant le succès de celle-ci. Ces techniques de réduction sont de réalisation aisée et rapide, avec un taux de succès très élevé. Selon les méta-analyses, la technique en pronation forcée, considérée comme étant plus efficace, devrait être préférée en première intention. Ainsi, nous proposons un algorithme simple de prise en charge rapide de la subluxation de la tête radiale aux urgences reposant sur l’évaluation clinique et l’utilisation préférentielle de la manoeuvre de réduction en pronation forcée.

Abstract

Radial head subluxation, which is also called “pulled elbow”, is secondary to displacement of the annular ligament in the radiohumeral joint. This is a common musculoskeletal pediatric injury in emergency departments. A specific reduction is necessary to release the trapped annular ligament. There are two major methods for manipulative reduction. The first one is the classic supination–flexion technique and the second one is the hyperpronation technique with a palpable click in the region of the radial head, which is a sign of success. These reduction techniques are quick and easy to realise with a very high rate of success. According to metaanalysis, the hyperpronation technique, which is considered to be more effective, should be preferred as the first choice. Thus, we suggest a simple and prompt algorithm for the management of radial head subluxation in emergency departments based on clinical features and the use of the most preferred manual reduction, the hyperpronation technique.

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  1. Service urgences, Smur, UHCD, consultation de médecine et traumatologie du sport, centre hospitalier Sud-Gironde, rue Paul-Langevin, F-33210, Langon, France

    D. Tourdias

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Correspondence to D. Tourdias.

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Tourdias, D. La subluxation de la tête radiale ou « pronation douloureuse ». Ann. Fr. Med. Urgence 7, 299–306 (2017). https://doi.org/10.1007/s13341-017-0762-4

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  • DOI: https://doi.org/10.1007/s13341-017-0762-4

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