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Efficacy of Reduction Maneuvers For “Pulled Elbow” in Children: A Prospective Study of 115 Cases

García-Mata, Serafín MD; Hidalgo-Ovejero, Angel MD

Journal of Pediatric Orthopaedics: June 2014 - Volume 34 - Issue 4 - p 432–436
doi: 10.1097/BPO.0000000000000130
Upper Extremity

Background: 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).

Methods: 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.

Results: 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).

Conclusions: 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.

Department of Orthopedic Surgery and Trauma, Complejo Hospitalario de Navarra, Pamplona, Spain

None of the authors received financial support for this study.

The authors declare no conflicts of interest.

Reprints: Serafin García-Mata, MD, Complejo Hospitalario de Navarra. Sección de Ortopedia y Traumatología Infantil. Servicio de Cirugía Ortopédica y Traumatología. C/Irunlarrea 4. 31008-Pamplona. Spain. E-mail:

© 2014 by Lippincott Williams & Wilkins