Comparison of hyperpronation and supination-flexion techniques in children presented to emergency department with painful pronation

Güzel, Murat; Salt, Ömer; Demir, MT; Akdemir, HU; Durukan, Polat; Yalcin, Anil

doi:10.4103/1119-3077.127557

Cited by 13 publications

(3 citation statements)

References 10 publications

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“…Based on the FLACC scale and Wong-Baker faces pain rating scale, no significant difference in pain levels before and after reduction was found between the two groups (p ¼ 0.462). 16 In another study, Ulici et al showed that HP was more successful than SF on the first attempt (85 vs. 53%), with no significant difference in pain levels before and after reduction. 13 García-Mata et al and few other researchers also reported that HP was more successful than SF on the first attempt.…”

Section: Discussionmentioning

confidence: 95%

Hyperpronation versus Supination–Flexion in Radial Head Subluxation Reduction: A Randomized Controlled Trial

Porozan

Forouzan

Hassanzadeh

2020

J Pediatr Intensive Care

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Radial head subluxation (RHS) is the most common upper extremity injury in children. Supination–flexion (SF) and hyperpronation (HP) are two methods for reducing this subluxation. This study purposed to compare the success rates of two methods of reduction and also to determine which technique would be less painful. In total, 154 patients with RHS were enrolled in this study and randomized into two groups. Patients were to undergo reduction by one of the two methods; if the primary attempt was unsuccessful, a second attempt was performed using the alternate technique. In the case of failure of the second attempt, the first reduction technique was repeated. The success rates and pain levels before and after successful reduction were recorded. On the first attempt, 72 of 77 patients who underwent HP had a successful reduction. Four patients in the HP group had a successful reduction on the second attempt. In the SF group, 76 of 77 patients had a successful reduction on the first attempt. The success rate on first attempts was higher in the SF group than in the HP group (p = 0.043). Pain levels before and after reduction were not statistically different between the groups (p > 0.05). The SF technique had a higher success rate at first attempt to reduce RHS, but pain levels were similar in both methods.

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Section: Discussionmentioning

confidence: 95%

Hyperpronation versus Supination–Flexion in Radial Head Subluxation Reduction: A Randomized Controlled Trial

Porozan

Forouzan

Hassanzadeh

2020

J Pediatr Intensive Care

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“…There has been lot of literature support for hyper-pronation maneuver for reducing the pulled elbow with some studies proving it more efficient for reduction of pulled elbows in the first attempt . [3]. In this instead of supinating the forearm, a thumb is kept over the radial head and forearm is completely pronated to more than the entire normal range.…”

Section: Reductionmentioning

confidence: 99%

Managing a pulled elbow in the clinic

Shah¹,

Agashe²

2022

Jcorth

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Pulled elbow is one of the commonest clinical conditions encountered by the Paediatric orthopaedic surgeon. It is primarily due to axial force applied to a semi-prone forearm which leads to proximal radio-ulnar joint dislocation. Diagnosis is usually clinical and radiographs are rarely needed. Reduction maneuvers include the Traction-supination and traction-hyperpronation method and almost always cause immediate pain relief and return to function.

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“…Авторы отмечают, что согласно опросу 39 специалистов, выполнявших репозицию, гиперпронационный метод по технике исполнения легче, чем супинационно-флексионный (р = 0,003) [25]. Однако, по другим данным, болевые ощущения при использовании обоих методов репозиции не различаются [45,48]. По мнению R. Bexkens et al, исследования, в которых авторы сравнивают болевые ощущения, имеют значительные погрешности, связанные с субъективностью оценки боли, отсутствием «слепой» оценки и трудностью интерпретации болевых ощущений у детей раннего возраста.…”

Section: лечениеunclassified

Current views on radial head subluxation

Petrushin

Леонидович²,

Bragina

et al. 2020

Pediatr Traum Orthop Reconstr Surg

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Backgrоund. Radial head subluxation is the most common injury in young children and accounts for 2.6% of the total population in this age group. In 39%82% of cases, the mechanism of injury is the traction of the arm, but subluxation can occur during a fall and in other circumstances; in 19%51% of cases, the mechanism of injury is unknown. Aim. The purpose of this study is to generalize and arrange the available literature and data and present current views on the prevalence, etiology, pathogenesis, diagnosis, and treatment of radial head subluxation in children. Materials and methods. A literature search was performed using the PubMed, PubMed Central, Google Scholar, CNKI-Scholar, Cyberleninka, and eLibrary databases. The sample of sources was mainly limited to 20002019. Results. The cause of subluxation is the displacement of the annular ligament and its interposition in the humeroradial joint. It is determined by a number of features of the elbow joint anatomy in young children. Diagnosis of radial head subluxation is based on history and clinical data; radiography and ultrasonography are used to obtain a clear clinical picture and to exclude fractures. The mainstay of treatment is a closed reduction, which is conducted via two methods as follows: supinationflexion and hyperpronation. According to modern research data, preference is given to the hyperpronation method; it is more effective in terms of number of reduction attempts, is technically simpler and, possibly, less painful. Generally, immobilization after effective reduction is not required as the function of the elbow joint is fully restored. A consequence of radial head subluxation is recurrence, which occurs in 5%46% of cases. A factor associated with recurrence is being less than two years of age. The prophylaxis of radial head subluxation is aimed at preventing forceful arm traction in children under three years of age and involves educating the parents or caregivers in the symptoms of subluxation to prevent late admission. Conclusions. Radial head subluxation is found in young children and is mainly diagnosed clinically. The treatment consists of a closed reposition, and the prognosis for restoring limb function is favorable.

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Comparison of hyperpronation and supination-flexion techniques in children presented to emergency department with painful pronation

Cited by 13 publications

References 10 publications

Hyperpronation versus Supination–Flexion in Radial Head Subluxation Reduction: A Randomized Controlled Trial

Hyperpronation versus Supination–Flexion in Radial Head Subluxation Reduction: A Randomized Controlled Trial

Managing a pulled elbow in the clinic

Current views on radial head subluxation

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