title: Comparison of success and pain levels of supination-flexion and hyperpronation maneuvers in childhood nursemaid's elbow cases.
abstract: OBJECTIVE
  The aim of this study was to compare the hyperpronation (HP) and the supination-flexion (SF) reduction techniques for reducing nursemaid's elbow in terms of efficacy and pain.
  
  
  METHODS
  This prospective, pseudorandomized, controlled, nonblinded study was conducted in an urban tertiary care emergency department between October 1, 2009, and October 1, 2010. A total of 150 patients (51 males [34%] and 99 females [66%] between the ages of 0 to 6 years) were included in the study. When the first reduction attempt failed, second attempt was performed using the same technique. After failure of the second attempt, reduction technique was changed to an alternate technique. Level of pain was evaluated using the Modified Children's Hospital of Eastern Ontario Pain Scale in 113 patients older than 1 year who had a successful reduction process on the first attempt.
  
  
  RESULTS
  Successful reduction was accomplished in 121 (80.7%) of the patients during the first attempt, in 56 (68.3%) of the patients using the SF technique and in 65 (95.6%) of the patients using the HP technique (P < .001). At the end of total attempts, we found that the SF (59/84) technique was less successful than the HP (91/93) technique (P < .001). The pain levels of the both techniques were not statistically different.
  
  
  CONCLUSIONS
  The HP technique was found to be more successful compared with the SF technique in achieving reduction. We were unable to find any significant difference in pain levels observed between the 2 techniques.
authors.affiliation: Konya Training and Research Hospital, Department of Emergency Medicine, Konya, Turkey.
authors.forename: Yahya Kemal
authors.initials: YK
authors.lastname: Gunaydin
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Katirci
authors.forename: Hikmet
authors.initials: H
authors.lastname: Duymaz
authors.forename: Kubilay
authors.initials: K
authors.lastname: Vural
authors.forename: Huseyin Cahit
authors.initials: HC
authors.lastname: Halhalli
authors.forename: Mehtap
authors.initials: M
authors.lastname: Akcil
authors.forename: Figen
authors.initials: F
authors.lastname: Coskun
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D004204:Joint Dislocations / Q000628:therapy*; D008297:Male; D008349:Manipulation, Orthopedic / Q000009:adverse effects / Q000379:methods*; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D011403:Pronation; D013484:Supination; D016896:Treatment Outcome; D000092464:Elbow Injuries