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

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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)1137-1144
Number of pages8
JournalEuropean Journal of Orthopaedic Surgery and Traumatology
Issue number6
StatePublished - Aug 2022
Externally publishedYes


  • Children
  • Epidemiology
  • NEISS database
  • Nursemaid’s elbow
  • Radial head subluxation
  • RHS

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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