A mother pulls her 3-year-old child up by one arm. The child then holds the arm pronated, slightly flexed, and refuses to use it. There is no swelling or deformity. The most appropriate management is:

• A Immobilisation in an above-elbow cast for three weeks
• B Reduction by supination of the forearm followed by flexion of the elbow ✓
• C Closed reduction and percutaneous pinning of the radial neck
• D Surgical exploration and repair of the annular ligament

Explanation

Longitudinal traction on a young child's arm pulls the annular ligament over the radial head, causing radial head subluxation, also called pulled elbow or nursemaid's elbow. Reduction is achieved by supination of the forearm with the elbow flexed (often with a palpable click), restoring immediate function. Immobilisation and surgery are reserved for recurrent cases only, and this injury involves no fracture requiring fixation.

Reference: Apley's System of Orthopaedics and Fractures, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.