Comparative effectiveness of supination-flexion and hyperpronation maneuvers in radial head subluxation: A systematic...

Radial head subluxation (RHS) is a frequent upper extremity injury in preschool children. Although the supination-flexion method is traditionally used for reduction, the 2017 Cochrane Review systematic review has shown that the hyperpronation maneuver is more successful. Despite the Cochrane Review suggesting that hyperpronation could be the preferred first-line technique in clinical practice, the studies analyzed have been deemed to carry a high risk of bias due to various methodological issues. This systematic review and meta-analysis aimed to reevaluate the evidence by including both prior and recently published randomised controlled trials (RCTs) comparing the two techniques.

PubMed, Embase, and Web of Science databases were searched and reviewed from 1980 to 2024 using specific search criteria without any language restriction. This systematic review and meta-analysis focused on randomised controlled trials (RCTs) that compared supination/flexion techniques to hyperpronation techniques for reducing radial head subluxation in children aged 0 to 6 years. The risk of bias in all included studies was assessed using the Revised Cochrane Risk of Bias tool (ROB-2). The quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

A total of 11 studies met the inclusion criteria, with ten assessed as high risk of bias and one as low risk. The pooled data demonstrated that hyperpronation had significantly lower first-attempt failure rates compared to supination-flexion (9.42 % vs. 25 %). Pain levels during the maneuvers were comparable, with slight advantages for hyperpronation noted in a few subjective assessments.

Despite the predominance of low-quality evidence, the findings suggest hyperpronation as the preferred technique for RHS reduction due to its higher success rates and simplicity.