Suggestion of a Modified Reduction Maneuvers with Parents in the Pulled Elbow Children

PURPOSE: If radial head subluxation, otherwise known as pulled elbow, occurs, closed reduction can be used in simultaneous diagnosis and treatment of the child. As the guardian seldom understands the maneuver without explanation, we revised a method to involve the caregiver in the treatment. METHODS: This was a prospective controlled study. From January, 2014 to December, 2014, children suspected of radial head subluxation, under the age of 6, were enrolled. Patients were randomly assigned to two groups. One group was treated conventionally and the other group was treated while the parent's finger was on the patient's lateral epicondyle. A total of three attempts were made using the hyperpronation method and the supination-flexion method. The physician then recorded whether the treatment was successful, the number of attempts, easiness of the reduction, and guardian's degree of understanding and satisfaction. RESULTS: A total of 116 patients were enrolled. The number of attempts was 1.27 and 1.35 times in the experimental group and the control group, respectively. The success rate was 96.6% in the experimental group and 94.7% in the control group. There was no statistically significant difference within the two groups. The physicians found that the revised method was as easy as the conventional method and the caregiver's degree of understanding was higher in the experimental group. CONCLUSION: As the revised method increases the degree of guardians' understanding and does not increase the difficulty of the procedure, we recommend using the revised method in treatment of radial head subluxation.

A Case of Acute Appendicitis of Children which its Symptoms and Signs were Self-disappeared

Acute appendicitis is a disease resulting from inflammation of the appendix. The most common symptoms and physical examinations are the following: right lower abdomen pain, tenderness, rebound tenderness, nausea, vomiting, and fever. The clinician makes a diagnosis based on these symptoms and physicals along with ultrasonography or radiologic imaging, such as computed tomography (CT), forviewing of the inflamed appendix. In this case a seven-year-old-male visited the Emergency Room with abdominal pain and tendernessin in the right lower quadrant, whose symptoms disappeared spontaneously without treatment, although the bedside ultrasonography showed an inflamed appendix. The patient underwent surgery and the operation findings indicated a concordant diagnosis. We report this case as the cardinal symptom of acute appendicitis has been right lower quadrant pain for many years, which may lead to misdiagnosis.