The pronation method (with the hand downward) may be more successful in repositioning at first attempt for children with a pulled elbow. We ...JumptonavigationLanguage:EnglishDeutschEspañolFrançais日本語தமிழ்MorelanguagesavailableShowfewerlanguagesCoronavirus(COVID-19)resourcesDifferentmethodsofmanipulationforreducingpulledelbowinyoungchildrenWhatispulledelbow?Pulledelbowisadislocationoftheelbowjointinayoungchildwhichisoftencausedbyanadult,ortallerperson,suddenlypullingortuggingonthechild'sarmwhenitisstraight,orwhenachildpullsawayfromanadultimpulsively. Itcanalsobecausedbyafallortwist.Thechildimmediatelycomplainsofpainandcannotusehisorherarm.Howisittreated?Treatmentusuallyconsistsofmanipulatingthearmtogetthebonesoftheelbowbackintotheircorrectposition.Itisusuallytreatedbymanualintervention.Therearetwotypicalmanoeuvres,supinationandpronation.Insupination,theforearmistwistedorrotatedoutwards(palmofchild’shandfacesupwards),sometimesfollowedbybendingoftheelbow(flexion).Whilethisisoftenused,itisnotalwayssuccessful.Inpronation,theforearmistwistedorrotatedinwards(palmofchild’shandfacesdownwards).Bothmethodsaregenerallysafe,althoughbruisingcanoccurandtheycanbepainful.ResultsofthesearchWesearchedmedicalliteraturedatabasesuptoSeptember2016.Wefoundninesmallstudiesinvolvingatotalof906children,allofwhomwereyoungerthansevenyearsold.Aroundsixoutof10childrenweregirls.Eightstudieswereperformedinemergencydepartmentsorambulatorycarecentres.Onestudywasperformedinaspecialistpaediatricorthopaedicunit.Eighttrialscomparedpronationversussupination.Onecomparedtwomethodsofsupination.KeyresultsThepronationmethod(withthehanddownward)maybemoresuccessfulinrepositioningatfirstattemptforchildrenwithapulledelbow.Weestimatedthatifsixchildrenweretreatedwiththepronationmethodratherthanthesupinationmethod,thiswouldavoidonemorefailureatthefirstattempt.Theevidencewasinsufficienttodrawanyconclusionsastowhich,ifeither,ofthetwomethodswasmorepainful.Wheretherewasasecondattemptusingthesamemethod,pronationmaybemore