title: Efficacy of reduction maneuvers for "pulled elbow" in children: a prospective study of 115 cases.
abstract: BACKGROUND
  The objective of our study is to determine the relative efficacy of the 2 reduction maneuvers, hyperpronation (HP) and supination-flexion (SF), in pulled elbow (PE).
  
  
  METHODS
  We conducted a randomized, prospective study of 2 reduction maneuvers in 115 patients with PE and a mean age of 2 years and 3 months. Patients were randomly divided into 2 groups: group A, with 65 children (56.52%) who underwent HP; and group B, with 50 children (43.47%) who underwent SF.
  
  
  RESULTS
  In 97.39% of the children, reduction was achieved by manipulation. Reduction was achieved at first attempt (using either maneuver) in 101 of 115 patients (87.82%), with 93.84% success for HP and 80% for SF (P=0.0243). Most patients in whom our first attempts failed (85.71%) had undergone prior manipulation: 100% of treatment failures from group A; and 80% of failures from group B. Most (95.04%) patients in whom our first attempts succeeded had not undergone prior manipulation: 93.44% from group A; and 97.5% from group B. A significant relationship was found when comparing those who had undergone prior manipulation from group A (P=0.0001) and group B (P=0.000000072).
  
  
  CONCLUSIONS
  Although both SF and HP are effective for reduction of PE, a higher first-attempt success rate was achieved by HP, and this should therefore be the first maneuver used. In recurring cases, it would seem appropriate to teach the child's parents the HP maneuver as the most effective and easiest to do.
authors: Department of Orthopedic Surgery and Trauma, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors: Serafín
authors: S
authors: García-Mata
authors: Angel
authors: A
authors: Hidalgo-Ovejero
mesh_terms: D017760:Bone Malalignment / Q000503:physiopathology / Q000628:therapy*; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007103:Immobilization; D007223:Infant; D008297:Male; D008349:Manipulation, Orthopedic; D011403:Pronation; D011446:Prospective Studies; D011884:Radius / Q000002:abnormalities* / Q000503:physiopathology; D016059:Range of Motion, Articular; D012008:Recurrence; D013484:Supination; D017211:Treatment Failure; D016896:Treatment Outcome; D000092464:Elbow Injuries