Nursemaid's Elbow – Supination-flexion Technique Versus Hyperpronation/forced Pronation: Randomized Clinical Study

BACKGROUND: Nursemaid's elbow (NE) represents the most common pathology met in the pediatric orthopedics ambulatory. There are two techniques of reducing the NE: the supination-flexion technique and the hyperpronation or forced pronation technique. MATERIALS AND METHODS: In this randomized clinical study, we aim to compare the two reduction techniques of the NE, by measuring the effectiveness of each and scaling the pain felt by the child, by using the Faces Pain Scale. The study included 116 patients with typical presentation for NE with age under 7 years old (mean age ~3 years old), 45% of males and 55% of females. RESULTS: Hyperpronation was found to be more successful than supination-flexion technique as a first attempt (85% vs. 53%), second attempt (50% vs. 28%), and as a crossover technique (100% vs. 50%) when supination-flexion failed. CONCLUSIONS: This study concludes that hyperpronation technique should be used as a first maneuver reduction in treating NE, a simple one-movement technique.