Upper-extremity impairment in young children.

STUDY OBJECTIVE: To determine the spectrum of disorders in children younger than 6 years with upper-extremity injury or immobility and to identify clinical findings associated with specific disorders.

DESIGN: Prospective patient series.

SETTING: Urban pediatric emergency department.

PARTICIPANTS: Children younger than 6 years seen during a 6-month period with injury or immobility of an upper extremity.

RESULTS: We identified 178 episodes of immobility or injury of an upper extremity. Radial head subluxation (RHS) was the most frequent diagnosis (63%; 99 definite and 13 probable), followed by fracture (22%) and soft-tissue injury (STI; 13%). One patient each had humeral osteomyelitis and neurologic impairment. The mean age of children with RHS was significantly less than that of children with fractures (27 +/- 12 months versus 39 +/- 19 months, P < .01); the only diagnoses in children younger than 4 months old were infection and neurologic impairment. Multivariate regression analysis showed point tenderness and swelling correlated with fractures (P < .05). Decreased arm movement, absence of swelling, and a pull as the mechanism of injury correlated with RHS (P < .05). However, arm traction occurred in only 55% of the children with RHS (95% confidence interval = .46 to .64). By 1 week after the evaluation, all children without fractures had recovered, except one each with a sprain, osteomyelitis, and neurologic impairment.

CONCLUSION: Most children with arm injury or immobility have bony or soft-tissue trauma, the majority being RHS. Clinical findings varied between diagnoses and may aid the clinician in deciding whether attempted reduction of RHS is indicated or whether radiographs are warranted first. Nontrauma diagnoses are unusual but should be considered, particularly in the child younger than 6 months old. Appropriate immobilization and follow-up are important for the management of children without a clear diagnosis at the initial evaluation.