Comparison of Pain Scale on Two Different Manual Reduction Technique in Patients with Elbow Subluxation

ABSTRACT

PURPOSE: This research was done to assess the effectiveness of two manual reduction techniques for elbow subluxation and to determine which technique was less painful during trial of manual reduction. METHODS: A prospective, controlled, randomized survey was conducted on children who presented to the Emergency Department (ED) of an inner-city university hospital with clinical features and physical findings suggestive of an elbow subluxation between Mar 1, 2007 and February 28, 2008. We evaluated the success rate of each reduction technique and the pain scale during trial of manual reduction. We classified each group into 2 subgroups (under 3 years of age and over 3 years of age) for evaluating the pain score. The degree of pain was determined using the FLACC scale (under 3 years of age) and faces pain scale (over 3 years of age). RESULTS: One hundred and four children were enrolled in our study and they were equally divided into a supination group (SG) and a pronation group (PG). There was no statistically significant difference with regards to the demographic data between the two groups. The success rate for the SG was 85.7% and for PG was 91.7% (p=0.32). For patients under 3 years of age, the FLACC scale for the SG was 5.14 and for PG was 3.82 (p=0.01). For patients over 3 years of age, the face pain scale for the SG was 5.5 and for PG was 5.54 (p=0.83). CONCLUSION: Both reduction techniques are useful for reducing elbow subluxations. In case of children under 3 years old, we believe that the pronation technique is a better option due to lesser pain produced compared to the supination technique.