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Pediatr Emerg Care. 2020 Mar 6. doi: 10.1097/PEC.0000000000001963. [Epub ahead of print]

Nonaxial Traction Mechanisms of Nursemaid's Elbow.

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From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Children's Hospital, Loma Linda, CA.



This study aims to better describe those patients who present with nonaxial traction mechanisms for nursemaid's elbow.


A retrospective review on patients with the International Statistical Classification of Diseases, Ninth/Tenth Revision, code for nursemaid's elbow was performed. Patients with the classic axial traction mechanism and unknown mechanism were excluded. Demographic information and mechanism of injury were collected, and statistical analysis on this data was performed.


Sixty-nine subjects with a median age of 2.4 years (interquartile range, 1.5-3.6 years) were enrolled. There was no difference in sex or sidedness. The most common mechanisms of injury were fall (57%), direct hit to the elbow (16%), and rolling over (7%). An x-ray was obtained 49% of the time. Reduction was spontaneous 12% of the time and was successfully reduced on the first attempt 87% of the time.


Nursemaid's elbow can occur in children with a reported nonaxial traction mechanism. They may present with history of other trauma, such as a fall, a direct blow to the elbow, or rolling over. For toddlers without the classic axial traction mechanism who refuse to move the elbow but do not have an examination consistent with fracture, it is still reasonable to suspect a nursemaid's elbow.

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