Category: Pediatrics
Keywords: supination with flexion, hyperpronation (PubMed Search)
Posted: 5/4/2018 by Sarah Kleist, MD
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Nursemaid’s elbow is a common pediatric injury with peak incidence occurring between two and three years of age. It is a condition that typically arises from a sudden upward pull of the arm as an axial traction is placed on the forearm, and the radius is pulled through the annular ligament, resulting in subluxation of the radial head. Over the years, various maneuvers have been attempted, but the two most common are supination with flexion and hyperpronation. A 2017 Cochrane meta-analysis analyzed 8 trials specifically comparing supination with flexion versus hyperpronation. Data from those trials suggested that hyperpronation resulted in less failures at ?rst attempt than the supination-?exion, and although there was limited data, there was no obvious difference in adverse events or pain between the two techniques.
Bottom Line: There is likely a lower risk of failure with first attempt reduction with hyperpronation than with supination-flexion for nursemaid’s elbow.
References:
1. Schutzman SA, Teach S. Upper-extremity impairment in young children. Ann Emerg Med. 1995;26:474-479.
2. Hart GM. Subluxation of the head of the radius in young children. J Am Med Assoc. 1959;169:1734-1736.
3. Vitello S, Dvorkin R, Sattler S, Levy D, Ung L. Epidemiology of Nursemaid’s Elbow. Western Journal of Emergency Medicine, Vol 15, Iss 4, Pp 554-557 (2014). 2014:554.
4. Macias CG, Bothner J, Wiebe R. A comparison of supination/flexion to hyperpronation in the reduction of radial head subluxations. Pediatrics. 1998;102:e10-e10.
5. Bexkens R, Washburn FJ, Eygendaal D, van den Bekerom M,P.J., Oh LS. Effectiveness of reduction maneuvers in the treatment of nursemaid's elbow: A systematic review and meta-analysis. Am J Emerg Med. 2016;34.
6. Krul M, van der Wouden J,C., van Suijlekom-Smit LW, Koes BW. Manipulative interventions for reducing pulled elbow in young children. Cochrane Database Syst Rev. 2009:CD007759.
7. Krul M, van der Wouden JC, van Suijlekom-Smit LW, Koes BW. Manipulative interventions for reducing pulled elbow in young children. Cochrane Database Syst Rev. 2012.
8. Krul M. Manipulative interventions for reducing pulled elbow in young children. Cochrane Database of Systematic Reviews. 2017.
