Comparison of Supination/Flexion Maneuver to Hyperpronation Maneuver in the Reduction of Radial Head Subluxations: A Randomized Clinical Trial

Comparison of Supination/Flexion Maneuver to Hyperpronation Maneuver in the Reduction of Radial Head Subluxations: A Randomized Clinical Trial

Authors

Gökhan Aksel, Burak Küka, Mehmet Muzaffer İslam, Furkan Demirkapı, İlknur Öztürk, Oğuz Mete İşlek, Enis Ademoğlu, Serkan Emre Eroğlu, Merve Osoydan Satıcı, Serdar Özdemir

Source

American Journal of Emergency Medicine, 2024

Conclusions

The hyperpronation maneuver demonstrated significantly higher first-attempt success rates compared to the supination/flexion maneuver for reducing RHS in children ≤6 years. Given its superior effectiveness on the first attempt and similar outcomes in secondary measures, the HP maneuver should be considered the preferred initial technique for managing radial head subluxation in pediatric patients.

Methods

  • Design: Randomized controlled trial
  • Participants: Children aged ≤6 years diagnosed with RHS in the ED.
  • Intervention: Patients were randomly assigned to the SF or HP maneuver groups.
  • Procedure:
    • Reduction success was assessed 10 minutes after the maneuver.
    • If the initial attempt failed, the maneuver was repeated up to three times.
    • Ultimate failure was defined as lack of reduction after three attempts.
  • Outcomes:
    • Primary: First-attempt success rate.
    • Secondary: Second-attempt success, ultimate failure, procedural pain, side effects, and recurrence within 72 hours.

Results

  • Total Participants: 119 children.
  • First-Attempt Success Rates:
    • HP group: 90.2% success.
    • SF group: 75.8% success.
    • Risk ratio: 0.41 (95% CI 0.19 to 0.98), favoring HP.
  • Other Findings:
    • No significant differences between HP and SF in:
      • Second-attempt success rates.
      • Ultimate failure rates.
      • Procedural pain.
      • Side effects.
      • Recurrence rates within 72 hours.
Aksel, G., Küka, B., İslam, M.M., Demirkapı, F., Öztürk, İ., İşlek, O.M., Ademoğlu, E., Eroğlu, S.E., Satıcı, M.O. and Özdemir, S., 2024. Comparison of supination/flexion maneuver to hyperpronation maneuver in the reduction of radial head subluxations: A randomized clinical trial. The American Journal of Emergency Medicine.
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