A COMPARISON OF SUPINATION FLEXION TO HYPERPRONATION IN THE REDUCTIONOF RADIAL HEAD SUBLUXATIONS/

Objective. To compare supination at the wrist followed by flexion at t he elbow (the traditional reduction technique) to hyperpronation at th e wrist in the reduction of radial head subluxations (nursemaid's elbo w). Materials and Methods. This prospective, randomized study involved a consecutive sampling of children younger than 6 years of age who pr esented to one of two urban pediatric emergency departments and two su burban pediatric ambulatory care centers with a clinical diagnosis of radial head subluxation. Patients were randomized to undergo reduction by one of the two methods and were followed every 5 minutes for retur n of elbow function. The initial procedure was repeated if baseline fu nctioning did not return 15 minutes after the initial reduction attemp t. Failure of that technique 30 minutes after the initial reduction at tempt resulted in a cross-over to the alternate method of reduction. T he alternate procedure was repeated if baseline functioning did not re turn 15 minutes after the alternate procedure was attempted. If the pa tient failed both techniques, radiography of the elbow was performed. Results. A total of 90 patients were enrolled in the study. Five patie nts were removed from further analysis secondary to a final diagnosis of fracture, 84 were reduced successfully, and 1 failed both technique s. Demographic characteristics of each group were similar. Thirty-nine of 41 patients (95%) randomized to hyperpronation were reduced succes sfully on the first attempt versus 34 of 44 patients (77%) randomized. to supination. Two patients in the hyperpronation group required two a ttempts versus 10 patients in the supination group. Hyperpronation was more successful; 40 of 41 patients (97.5%) in the hyperpronation grou p were reduced successfully versus 38 of 44 patients (86%) in the supi nation group. Of the 6 patients who crossed over from supination to hy perpronation, 5 were reduced on the first attempt and 1 was reduced on the second attempt. Conclusions. In the reduction of radial head subl uxations, the hyperpronation technique required fewer attempts at redu ction compared with supination, was successful more often than supinat ion, and was often successful when supination failed.