A Comparison of Two Methods in the Reduction of Radial Head Subluxations

ABSTRACT

PURPOSE: This study was conducted to compare the efficiencies of the supination to the hyperpronation method in reducing radial head subluxations. METHODS: This randomized, prospective study was done in a tertiary urban emergency medical center from January 2003 through December 2003. Inclusion criteria included age < 7 years with a clinical diagnosis of radial head subluxation. Exclusion criteria included point tenderness, echymosis, edema, deformity, and persistent pain. Patients were randomized for trearment by using either the supination or the hyperpronation method. The initial method was repeated if elbow function did not return 15 minutes after the reduction attempt. If the second attempt also failed, radiography of the elbow was performed. If the patient revisited the emergency medical center or orthopedic outpatient department within 24 hours with same complaint, we considered the attempt to be a failure. RESULTS: A total of 140 patients were enrolled in the study. The demographic characteristics of the two groups were similar. Seventy-two of the 75 patients (96%) randomly chosen for hyperpronation were reduced successfully on the first attempt versus 53 of 65 patients (81.5%) randomly chosen for supination (p=0.043). Seventy-four of 75 patients (98.7%) in the hyperpronation group were reduced successfully versus 61 of 65 patients (95.4%) in the supination group (p=0.183). For five patients, 4 patients in the supination group and 1 patient in the hyperpronation group, the reduction failed. CONCLUSION: Overall, in the reduction of radial head subluxations, there was no difference of success rate between the supination method and the hyperpronation method. However, the success rate of the hyperpronation method on the first attempt was superior to that of the supination method. We suggest that emergency physicians had better use the hyperpronation method rather than the supination method.