Although most elbow dislocations are reduced uneventfully under procedural sedation, the risks of entrapping a fracture fragment or a nerve in the joint space during the procedure are such that immediate orthopedic consultation is recommended (see Chapter 130 Procedures , section on Closed Reduction) Open reduction may be needed in over 50% of cases A repeat neurologic and vascular examination should be completed after ED reduction to assess for median or ulnar nerve entrapment and arterial compromise Persistence of vascular compromise indicates the need for emergent orthopedic consultation Postreduction radiographs are necessary to evaluate for associated fractures that may not be evident when the elbow is dislocated The patient with a reassuring postreduction examination may be placed in a posterior splint with the elbow at 90 degrees and with the forearm in midpronation for to weeks Discharge instructions should include signs of compartment syndrome and symptoms of motor and sensory deficit that require emergent follow-up Radial Head Subluxation CLINICAL PEARLS AND PITFALLS Dependent swelling of the wrist or hand may be noted in the child with a more prolonged period of subluxation Recovery of function after reduction may be more prolonged in younger children and those with greater than to hours of subluxation If reduction fails to return function, one must consider alternative diagnoses including fractures of the bones around the elbow or the clavicle, which may present similarly Radial head subluxation occurs when the annular ligament either tears or slips over the radial head in the setting of longitudinal traction on the arm, and then when traction is released, the ligament remains interposed between the radial head and capitellum This injury, known more often by its moniker, the “nursemaid’s elbow,” is among the most common traumatic injuries to the upper extremity It occurs most often among children from a few months to years old In children older than years, the radial head becomes ossified and less spherical and the strength of the annular ligament changes, making subluxation less common Classically, the child will present with the injured elbow pronated, partially flexed, and held at the side with a history of refusal to use the arm after being