Annular Pulled Elbow

A number of equivalent lesions have also been described. Commonest of these is the Type 1 variant Where the radial head is dislocated anteriorly but the ulna has plastic deformation rather than a fracture. Other variants include dislocations with associated radial neck fractures, olecranon fractures and dislocations of the ulnar-humeral joint. In some respects, the pulled elbow , commonly seen in infants, can also be considered a Bado I equivalent. The injury occurs when the elbow has traction applied, usually resulting in hyperextension and pronation. The radial head subluxes through the annular ligament but does not truly dislocate and radiographs are either normal or will show an effusion with elevation of the fat pads. 

Pulled elbow does not require manipulation under anaesthesia. The forearm is flexed and supi-nated. Often this results in a gratifying pop and the child resumes normal activity. If this manoeuvre is unsuccessful, simply resting the arm in a sling will allow swelling in the annular ligament to subside and the radial head will reduce within 2-3 days. 

In pulled elbow , a common injury among children due to slipping of the annular ligament over the radial head following forceful pronation, US is able to depict an increased distance between the radial head and the humeral capitellum probably due to the impingement of the annular ligament (Kosuwon et al. 1993) - see also chapter 19. 

In the subluxed radial head, a condition which is commonly referred to as pulled elbow , the annular ligament slips over the radial head resulting in rota-... 

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