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

Abstract

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.

The Relationship between the Dominant Hand and the Occurrence of the Supracondylar Humerus Fracture in Pediatric Orthopedics

“…In order to correctly assess a supracondylar humerus fracture, clinical examination and conventional x-rays are needed [ 13 ]. Thus, the confusion between a supracondylar humerus fracture and a nursemaid’s elbow, another common elbow trauma in children under six, can be ruled out [ 14 ]. The treatment varies accordingly to the Gartland classification, ranging from closed reduction and casting to closed or open reduction and pinning using K wires [ 15 ].…”

Evaluating the Functional Outcomes and the Quality of Life for Pediatric Patients with Osteogenesis Imperfecta after Fracture Treatment with Intramedullary Rodding

“…For pain intensity assessment, we used the Numerical Rating Scale for patients older than ten years, and the Wong-Baker Faces Pain Rating Scale/Faces Pain Scale for pediatric patients between the ages of 3 and 10 [9, [13][14][15][16][17].…”

Current views on radial head subluxation

“…В последнем из опубликованных рандомизированных контролируемых исследований, в которое вошли 116 пациентов и которое не было учтено в упомянутых выше обзорах, гиперпронационный метод также признан более эффективным, чем супинационно-флексионный: репозиция с первой попытки достигнута у 85 против 53 % пациентов, со второй попытки -у 50 против 28 % пациентов. При неудаче супинационно-флексионного метода репозиция с помощью гиперпронационного метода была успешной в 100 % случаев [43]. По мнению D. Bek et al, оба метода патогенетически сходны, но в случае супинационно-флексионного метода, при котором предплечье из положения пронации переводят в супинацию, приходится преодолевать механическое сопротивление сместившейся связки, что вызывает затруднения и дополнительную боль [25].…”