Effects of obtaining plain radiographs in pediatric patients with radial head subluxation

Purpose: This study investigated the rate and factors of spontaneous reduction (SR) during plain radiography in pediatric patients with radial head subluxation (RHS).Methods: We retrospectively reviewed patients aged 5 years or younger with RHS who visited a tertiary hospital emergency department (ED) from March 2015 through February 2022. They were classified into the SR during X-ray, manual reduction (MR) after X-ray, and MR-first groups. We compared the clinical variables, such as ED length of stay, among the 3 groups, and investigated factors associated with SR during radiography.Results: Among a total of 550 enrolled patients, 153 (27.8 %), 177 (32.2%), and 220 (40.0%) belonged to the SR during X-ray, MR after X-ray, and MR-first groups, respectively. Among the groups, no difference was found in the proportions of indoor injury (SR during X-ray, 92.6% vs. MR after X-ray, 79.0% vs. MR-first, 89.0%; P = 0.066). The mean ED length of stay was shorter in the MR-first group than in the equivalent values of the other groups (23.1 minutes vs. 49.0-53.0 minutes; P < 0.001), without differences in the other time intervals. The sole factor associated with SR during radiography was the indoor injury (odds ratio, 3.32; 95% confidence interval, 1.01-10.88; P = 0.048). Conclusion: Based on the results of this study, emergency physicians or pediatricians might consider obtaining radiographs first in patients with RHS injured indoors, which can cause SR and exclusion of complications such as iatrogenic injury.