In 2013, a recent study conducted by Yahya Kemal Gunaydin, et. al., the effectiveness and pain levels associated with two commonly used techniques for reducing nursemaid’s elbow in children were thoroughly examined. Nursemaid’s elbow, also known as radial head subluxation, is a common pediatric injury that results from the displacement of the radial head from the annular ligament, causing discomfort and pain in affected children.

The study, conducted between October 1, 2009, and October 1, 2010, at an urban tertiary care emergency department, enrolled a total of 150 young patients aged between 0 and 6 years, consisting of 51 males and 99 females. The research aimed to compare the success rates and pain levels associated with the hyperpronation (HP) and the supination-flexion (SF) reduction techniques.

The researchers employed a prospective, pseudorandomized, controlled, and non-blinded methodology. In cases where the initial reduction attempt failed, a second attempt was made using the same technique. If the second attempt also proved unsuccessful, the reduction technique was switched to the alternative method. Pain levels were assessed using the Modified Children’s Hospital of Eastern Ontario Pain Scale, focusing on 113 patients aged over 1 year who experienced successful reduction during the first attempt.

The results of the study revealed that the HP technique yielded a notably higher rate of successful reduction, achieving success in 95.6% of patients, compared to 68.3% success with the SF technique during the first attempt. Overall, at the conclusion of all attempts, the HP technique continued to outperform the SF technique, with a success rate of 91 out of 93 cases for HP, compared to 59 out of 84 cases for SF.

An interesting finding of the study was that while the success rates varied significantly between the two techniques, the levels of pain experienced by the patients during the reduction process did not show any statistically significant difference. This suggests that both the hyperpronation and the supination-flexion techniques are equally well-tolerated by young patients in terms of pain.

In summary, this study’s findings indicate that the hyperpronation technique is more successful than the supination-flexion technique for achieving nursemaid’s elbow reduction in children. However, the choice between these methods can be made based on factors other than pain levels, as both techniques appear to offer a similar level of comfort during the reduction process. These insights can assist healthcare professionals in making informed decisions when managing nursemaid’s elbow cases in pediatric patients.

Reference: Gunaydin, Y. K., Katirci, Y., Duymaz, H., Vural, K., Halhalli, H. C., Akcil, M., & Coskun, F. (2013). Comparison of success and pain levels of supination-flexion and hyperpronation maneuvers in childhood nursemaid’s elbow cases. The American Journal of Emergency Medicine, 31(7), 1078-1081.