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Trends and epidemiology of radial head subluxation in the United States from 2004 to 2018

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Increased body mass may predispose children to a greater risk for radial head subluxation (RHS). Recent studies in the literature have reported a plateau in obesity prevalence among infants and toddlers. This study sought to examine recent epidemiological trends in RHS incidence from 2004 to 2018 using the National Electronic Injury Surveillance System database to determine how obesity patterns may affect RHS incidence.

Methods

The National Electronic Injury Surveillance System (NEISS) database was queried for patients 6 years of age or younger presenting with radial head subluxation between January 1, 2004 and December 31, 2018. Patient demographics, mechanisms of injury, and location of injury were recorded.

Results

An estimated total 253,578 children 6 years or younger were treated for RHS with 14,204 (95% CI = 8124–20,284) in 2004 to 21,408 (95% CI = 12,882–29,934) in 2018. The overall annual rate of RHS per 10,000 children ≤ 6 years was 6.03 (95% CI = 4.85–7.58). The annual rate of RHS per 10,000 children ≤ 6 years increased (m = 0.200, ß = 0.802, p < 0.001) from 5.18 (95% CI 2.96–7.39) in 2004 to 7.69 (95% CI = 4.63–10.75) in 2018. The most common mechanism associated with RHS was falls (39.4%) with 103,466 (95% CI 74,806–132,125) cases. Pulls accounted for the second most common mechanism of injury, accounting for 90,146 (95% CI 68,274–112,018) cases or 36.2%. Yearly RHS incidence was compared to obesity prevalence for ages 2–5 children provided by the National Health and Nutritional Examination Survey (NHANES) surveys. Changes in obesity prevalence may visually reflect RHS incidence trends, but no causality between obesity prevalence and RHS incidence could be confirmed.

Conclusion

This study corroborated previous findings that falls and arm pulling contribute to the vast majority of RHS cases. The nonsignificant rise in RHS cases may reflect a possible plateau in obesity prevalence of children aged 2–5 years in recent years.

Level of Evidence

III.

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References

  1. Bexkens R, Washburn FJ, Eygendaal D et al (2017) Effectiveness of reduction maneuvers in the treatment of nursemaid’s elbow: a systematic review and meta-analysis. Am J Emerg Med 35:159–163. https://doi.org/10.1016/j.ajem.2016.10.059

    Article  PubMed  Google Scholar 

  2. Baiu I, Elliot Melendez M (2018) Nursemaid’s elbow (elbow subluxation). J Am Med Assoc 319:2018

    Google Scholar 

  3. Vitello S, Dvorkin R, Sattler S et al (2014) Epidemiology of nursemaid’s elbow. West J Emerg Med 15:554–557. https://doi.org/10.5811/westjem.2014.1.20813

    Article  PubMed  PubMed Central  Google Scholar 

  4. McCormack MP (1959) Pulled elbow. Br Med J 1:1240. https://doi.org/10.1136/bmj.1.5131.1240-b

    Article  PubMed Central  Google Scholar 

  5. Salter RB, Zaltz C (1971) Anatomic investigations of the mechanism of injury and pathologic anatomy of “pulled elbow” in young children. Clin Orthop Relat Res 77:134–143. https://doi.org/10.1016/0022-3468(72)90547-7

    Article  CAS  PubMed  Google Scholar 

  6. Irie T, Sono T, Hayama Y et al (2014) Investigation on 2331 cases of pulled elbow over the last 10 years. Pediatr Rep 6:26–28. https://doi.org/10.4081/pr.2014.5090

    Article  Google Scholar 

  7. Wong K, Troncoso AB, Calello DP et al (2016) Radial head subluxation: factors associated with its recurrence and radiographic evaluation in a tertiary pediatric emergency department. J Emerg Med 51:621–627. https://doi.org/10.1016/j.jemermed.2016.07.081

    Article  PubMed  Google Scholar 

  8. Welch R, Chounthirath T, Smith GA (2017) Radial head subluxation among young children in the united states associated with consumer products and recreational activities. Clin Pediatr (Phila) 56:707–715. https://doi.org/10.1177/0009922816672451

    Article  Google Scholar 

  9. Sekhobo J, Edmunds L, Whaley S, Koleilat M (2013) Obesity prevalence among low-income, preschool-aged children–New York City and Los Angeles County, 2003–2011. Morb Mortal Wkly Rep 62:17–22

    Google Scholar 

  10. Kern E, Chan NL, Fleming DW, Krieger JW (2014) Declines in student obesity prevalence associated with a prevention initiative–King County, Washington, 2012. Morb Mortal Wkly Rep 63:155–157

    Google Scholar 

  11. Berger M, Konty K, Day S et al (2011) Obesity in k-8 students–New York city, 2006–07 to 2010–11 school years. Morb Mortal Wkly Rep 60:1673–1678

    Google Scholar 

  12. Pan L, Freedman DS, Park S et al (2019) Changes in obesity among us children aged 2 through 4 years enrolled in wic during 2010–2016. JAMA 321:2364. https://doi.org/10.1001/jama.2019.5051

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ogden CL, Carroll MD, Lawman HG et al (2016) Trends in obesity prevalence among children and adolescents in the united states, 1988–1994 through 2013–2014. JAMA 315:2292. https://doi.org/10.1001/jama.2016.6361

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. The National Electronic Injury Surveillance System (NEISS). US Consumer Product Safety Commission. 2000. Accessed July 10, 2017 from https://www.cpsc.gov/cgibin/NEISSQuery/home.aspx

  15. US Census Bureau Population estimates. Accessed 12 Dec 2019 from http://www.census.gov/popest/

  16. Macias CG, Bothner J, Wiebe R (1998) A comparison of supination/flexion to hyperpronation in the reduction of radial head subluxations. Pediatrics 102:e10–e10. https://doi.org/10.1542/peds.102.1.e10

    Article  CAS  PubMed  Google Scholar 

  17. Schunk JF (1990) Radial head subluxation: epidemiology and treatment of 87 episodes. Ann Emerg Med 19:1019–1023. https://doi.org/10.1016/S0196-0644(05)82567-3

    Article  CAS  PubMed  Google Scholar 

  18. Quan L (1985) The Epidemiology and treatment of radial head subluxation. Arch Pediatr Adolesc Med 139:1194. https://doi.org/10.1001/archpedi.1985.02140140028018

    Article  CAS  Google Scholar 

  19. Rudloe TF, Schutzman S, Lee LK, Kimia AA (2012) No longer a “nursemaid’s” elbow: mechanisms, caregivers, and prevention. Pediatr Emerg Care 28:771–774. https://doi.org/10.1097/PEC.0b013e3182624906

    Article  PubMed  Google Scholar 

  20. Newman J (1985) “Nursemaid’s elbow” in infants six months and under. J Emerg Med 2:403–404. https://doi.org/10.1016/0736-4679(85)90247-1

    Article  CAS  PubMed  Google Scholar 

  21. Bek D, Yildiz C, Köse Ö et al (2009) Pronation versus supination maneuvers for the reduction of ‘pulled elbow’: a randomized clinical trial. Eur J Emerg Med 16:135–138. https://doi.org/10.1097/MEJ.0b013e32831d796a

    Article  PubMed  Google Scholar 

  22. Cohen-Rosenblum A, Bielski RJ (2016) Elbow pain after a fall: nursemaid’s elbow or fracture? Pediatr Ann 45:e214–e217. https://doi.org/10.3928/00904481-20160506-01

    Article  PubMed  Google Scholar 

  23. Centers for Disease Control and Prevention (CDC) (2020) National Health and Nutrition Examination Survey Data

  24. Pan L, Blanck HM, Park S, et al (2019). State-Specific Prevalence of Obesity Among Children Aged 2–4 Years Enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children–United States, 2010–2016. MMWR Morb Mortal Wkly Rep. 68:1057–1061. https://doi.org/10.15585/mmwr.mm6846a3

  25. Wen X, Gillman MW, Rifas-Shiman SL et al (2012) Decreasing prevalence of obesity among young children in massachusetts from 2004 to 2008. Pediatrics 129:823–831. https://doi.org/10.1542/peds.2011-1833

    Article  PubMed  PubMed Central  Google Scholar 

  26. Cantarero A, Myers O, Scharmen T et al (2016) Trends in early childhood obesity in a large urban school district in the Southwestern United States, 2007–2014. Prev Chronic Dis 13:150594. https://doi.org/10.5888/pcd13.150594

    Article  Google Scholar 

  27. Skinner AC, Ravanbakht SN, Skelton JA et al (2018) Prevalence of obesity and severe obesity in US Children, 1999–2016. Pediatrics 141:e20173459. https://doi.org/10.1542/peds.2017-3459

    Article  PubMed  Google Scholar 

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Funding

No sources of internal or external funding were sought after or utilized for completion of any aspect of this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA

    Jack J. Zhou, Neil V. Shah, Ryan C. Scheer, Jared M. Newman, Omar K. Hariri, Mikhail Tretiakov, Steven M. Koehler, Khalid Hesham, William R. Aibinder & Christopher R. Chapman

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  1. Jack J. Zhou
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  2. Neil V. Shah
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Correspondence to Neil V. Shah.

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Conflict of interest

No conflicts of interest influenced any aspect of this study. The following authors have no financial interests or conflicts to disclose: JJZ, NVS, RCS, JMN, OKH, MT, KH, WRA, CRC. SMK discloses the following: committee membership with the American Society for Surgery of the Hand (ASSH), medical advisory board membership and paid consultancy for Integra LifeSciences, speaker for TriMed Inc., and medical advisory board membership for Reactiv Inc.

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Zhou, J.J., Shah, N.V., Scheer, R.C. et al. Trends and epidemiology of radial head subluxation in the United States from 2004 to 2018. Eur J Orthop Surg Traumatol 32, 1137–1144 (2022). https://doi.org/10.1007/s00590-021-03089-8

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