PROSPECTIVE-STUDY OF RECURRENT RADIAL HEAD SUBLUXATION

Objectives: To calculate a recurrence rate for radial head subluxation (RHS) and to identify risk factors for recurrence. Design: Prospectiv e cohort study. Setting: Pediatric emergency department of an urban, t ertiary care children's hospital. Patients: Consecutive sample of 107 children younger than 6 years with definite (n=94) or probable (n=13) RHS enrolled during a 6-month period and followed up for at least 12 m onths. Main Outcome Measure: Recurrent episodes of RHS. Results: Follo w-up information was available on 86.9% (93/107) patients, with a mean +/-SD of 16.4+/-1.9 months (range, 12 to 20 months). Of these 93 patie nts, 22 (23.7%) had recurrent RHS. Among the patients who had their fi rst episode of RHS during the study period (n=76), those with recurren ces were significantly younger than those without (21.7+/-9.9 months v s 29.2+/-13.5 months, respectively, P=.04, t test). Those 24 months or younger had a relative risk of 2.60 for one or more recurrences durin g the study period (95% confidence interval, 1.04 to 6.30) compared wi th those older than 24 months. No differences were observed in duratio n of follow-up, sex, elbow involved in the initial episode, or family history of RHS between those with and without recurrences. Conclusions : Recurrent RHS occurs in nearly one fourth of patients, and those 24 months or younger are at greatest risk. Sex, family history, and the e lbow involved in the initial episode are not risk factors for recurren ce.