Hyperpronation Method for Reduction of Nursemaid's Elbow

Details for This Review

Study Population: Children younger than seven years with nursemaid's elbow

Efficacy End Points: Successful first attempt at reduction of radial head subluxation (nursemaid's elbow).

Harm End Points: Failure of reduction of nursemaid's elbow

Narrative: Radial head subluxation, also known as nursemaid's elbow, is a common injury in children younger than seven years, with peak incidence occurring between two and three years of age.1–3 It typically arises from a sudden upward pull of the arm. As axial traction is placed on the forearm, the radius is pulled through the annular ligament, resulting in subluxation of the radial head, which can cause acute onset of pain and limited mobility of the arm.2 This injury is treated with manual reduction of the subluxed radial head.1,2 Historically, various reduction maneuvers have been described, but the two most common are supination with flexion and the hyperpronation method.4,5 Supination-flexion is the traditional method taught in most textbooks; however, it is unclear whether either maneuver offers a higher rate of success while limiting potential adverse effects.

A 2017 Cochrane review included nine trials, eight of which specifically compared supinationflexion with the hyper-pronation method. A total of 811 children younger than seven years were recruited. Data from those trials suggested that hyperpronation resulted in a higher rate of first attempt success than supination-flexion (90.8% vs. 73.6%, respectively). This tra