Efficacy of reduction maneuvers for "pulled elbow" in children: a prospective study of 115 cases

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).

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.

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).

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.