Radial head subluxation: Comparing two methods of reduction

Objectives: To determine whether reduction of radial head subluxation (RHS) is more successful using pronation and flexion (PF) vs the more widely use d supination and flexion (SF) method. Methods: Prospective study in a terti ary care children's hospital ED from August 1996 through December 1997. Inc lusion criteria included age <7 years with an upper-extremity injury. Exclu sion criteria included neurologic impairment, congenital malformation, or o bvious bony deformity or edema. Patients were randomized to receive either PF or SF. Reduction was considered successful if the child used the injured arm. Both the physician and the parent rated the child's pain during the p rocedure using a descriptive ordinal scale, from 0 (no pain) to 3 (severe p ain). Results: 148 patients were enrolled; 13 were excluded. Success was ac hieved on the first attempt in 53/67 (80%, 95% CI = 0.67 to 0.88) of patien ts receiving PF and in 47/68 (69%, 95% CI = 0.57 to 0.80) of these receivin g SF (p = 0.186). For those injuring the left arm, 29/41 (71%, 95% CI = 0.5 4 to 0.84) were successfully reduced using SF, while 33/37 (89%, 95% CI = 0 .75 to 0.97) were successfully reduced using PF (p = 0.044). Physicians per ceived PF to be less painful than SF (p = 0.013). There was no significant pain score difference rated by parents. Conclusions: Both PF and SF can be used with success to reduce RHS. For left arm injuries, PF should be attemp ted first, since it may decrease the need for further treatment. PF may be less painful, particularly for first reduction attempts.