The treatment of pulled elbow: a prospective randomized study

Area of Science:

• Pediatric Orthopedics
• Musculoskeletal Injuries
• Evidence-Based Medicine

Background:

• Pulled elbow, also known as nursemaid's elbow, is a common injury in young children.
• It results from traction on the arm, causing the annular ligament to tear or subluxate.
• Recurrence after initial reduction can be a concern for parents and clinicians.

Purpose of the Study:

• To assess the efficacy of elbow splinting after manipulative reduction in preventing pulled elbow recurrence.
• To compare outcomes between children treated with splinting versus those treated with reduction alone.

Main Methods:

• A randomized controlled trial involving 64 children diagnosed with pulled elbow.
• Group A: Manipulative reduction followed by elbow splinting (flexed and supinated) for 2 days.
• Group B: Manipulative reduction only. Follow-up assessments at 2, 5, and 10 days.

Main Results:

• No recurrence of pulled elbow was observed in Group A (33 patients).
• Four patients (13%) in Group B (31 patients) experienced recurrence of pulled elbow within 2-5 days.
• Splinting demonstrated a statistically significant improvement in treatment success.

Conclusions:

• Elbow immobilization for two days post-manipulative reduction is an effective strategy to decrease pulled elbow recurrence.
• This simple intervention enhances treatment success rates for nursemaid's elbow in pediatric patients.