Objective: To compare two techniques of reduction of the pulled elbow 1. supination of the forearm followed by flexion of the elbow 2. hyperpronation of the forearm.

Material and methods: From July to October 2004, we studied 55 children with pulled elbow, aged below 4 years treated at the Emergency Department of the University Children’s Hospital of Belgrade. One patient was excluded from the study due to the fracture of the forearm.

The patients were divided into 2 groups according to the technique used in treatment.

Group 1: 23 pts treated by reduction supination / flexion technique,

Groups where randomized by:

A. Aged

From 14 months to 3 year, Mean: 22.22 months; Group 1; From 9 months to 3, 4 year, Mean: 22.79 months Group 2. P > 0,05

B. Time elapsed from injury to the medical treatment:

From 30 min. to 24 hours, Mean 508.7 min. Group 1 From 30 min. to 20 hours, Mean 368.2 min. Group 2, P > 0,05

C. Sex ratio M/F

13/10 group 1, 15/16 group 2, P > 0,05

D. Side L/R

14/9 group 1, 21/10 group 2 P > 0,05

E. Recurrence 4/23 group 1, 15/31 group 2 P > 0,05

Success of reduction was evaluated by

1/ The period elapsed until the return of function of the arm

2/ Checking the duration of the child crying

3/ Palpatory confirmation of successful reduction by palpable click-clackman.

Patients were followed every 30 sec during the first 5 min, and then every 5 to 30 min.

Results: 1/ After 30 min, in four children treated by supination flexion technique full function was not achieved, so we did another reduction using an alternative technique hyperpronation.

One patient from the second group was not successfully treated. P > 0.05

2/ Mean time of the period elapsed until the return of arm function was: Group 1 813,9 sec, Group 2 243,4 sec. P < 0.01

3/ Mean time when the child stopped crying was Group 1 408.3 sec, Group 2 223,2 sec. P < 0,01

4/ Palpatory confirmation of successful reduction -clackman was detected in Group 19/23 pts.,Group 30/31pts. P > 0.05

Conclusion: Our preliminary results of reduction of radial head subluxation using hyperpronation technique confirmed it to be to be simpler and more successful in reduction of the radial head dislocation, as shown by the mean time elapsed after the return of arm function and duration of child crying.