Objectives: To determine whether reduction of radial head subluxation (RHS) is more successful using pronation and flexion (PF) vs the more widely used supination and flexion (SF) method.
Methods: Prospective study in a tertiary care children's hospital ED from August 1996 through December 1997. Inclusion criteria included age <7 years with an upper-extremity injury. Exclusion criteria included neurologic impairment, congenital malformation, or obvious bony deformity or edema. Patients were randomized to receive either PF or SF. Reduction was considered successful if the child used the injured arm. Both the physician and the parent rated the child's pain during the procedure using a descriptive ordinal scale, from 0 (no pain) to 3 (severe pain).
Results: 148 patients were enrolled; 13 were excluded. Success was achieved on the first attempt in 53/67 (80%, 95% CI = 0.67 to 0.88) of patients receiving PF and in 47/68 (69%, 95% CI = 0.57 to 0.80) of those receiving SF (p = 0.186). For those injuring the left arm, 29/41 (71%, 95% CI = 0.54 to 0.84) were successfully reduced using SF, while 33/37 (89%, 95% CI = 0.75 to 0.97) were successfully reduced using PF (p = 0.044). Physicians perceived PF to be less painful than SF (p = 0.013). There was no significant pain score difference rated by parents.
Conclusions: Both PF and SF can be used with success to reduce RHS. For left arm injuries, PF should be attempted first, since it may decrease the need for further treatment. PF may be less painful, particularly for first reduction attempts.