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.

Unicameral bone cyst is a frequent benign lesion of the child’s skeleton of unclear ethopathology and scarce symptoms.Possible complications and limits in the child’s activities necessitate an active approach to management.

Intracystic injection of corticosteroid depot, curettage of the cyst and bone grafting and osteoinduction procedures are three frequently used therapeutic procedures.Having in mind that attitudes regarding initial treatment are still heterogeneous, in period 1992–2001, we have conducted a study aimed at making a comparative analysis of those commonly applied methods of treatment.

The prospective randomised study included 37 patients treated with corticosteroid injections, 32 patients treated with curettage and bone grafting and 31 patients treated with osteoinduction procedure.As osteoinductive material we used mixture of demineralised bone matrix powder and autologous bone marrow.

Results evaluation was based on criteria designed by Neer,Campannaci and Capanna.Mean follow up period was 6,5 years.

In our patients results of initial treatment were good, regardless of the applied method and they do not significantly differ from the results of other authors.No significant difference in treatment outcome was statistically revealed and frequency of recurrence does not vary in relation to applied method.

Mean failure rate was 18%,mean recurrence rate 10% and mean rate of usual complications 17%.

Under conditions of similar efficiacy, it is justified to apply a less invasive method in the initial treatment.

Methods of corticosteroid injection and osteoinduction are advantageous in cysts with physeal and epiphyseal propagation especially in the upper limb. Besides, those methods are characterised by simplicity, safety and short duration of intervention and hospitalisation and short limitation of the child’s activity.In exceptionally large cysts, as well as in cysts localised in the femoral neck and complicated with displaced fracture which requires reposition and osteosynthesis, the advantage is given to curetage and bone grafting.