A 2009 paper by Bek et al described a method of pronation instead of supination-​flexion1. The proposed maneuver involves one hand holding the elbow at 90 ...FeaturedJoboftheDayEmergencyDepartmentMedicalDirectorNavigateYouareat:Home»CurrentFeatures»QuickTrick:HyperpronationofNursemaid’sElbowTwitterFacebookGoogle+LinkedInEmail9CommentsParentsbringintheirdaughterbecausetheypulledonherarm,andnowsheisnotusingit.Theyarethoroughlyconvincedthatthechild’sarmiseitherbrokenordislocated.Weallrecognizethisasradialheadsubluxationor“nursemaid’selbow”andimmediatelyattempttoreduceit.Theprovidertakestheinjuredarm,supinatesatthewristandflexesattheelbow.Doesthechildscream? ADVERTISEMENTTheCaseParentsbringintheirdaughterbecausetheypulledonherarm,andnowsheisnotusingit.Theyarethoroughlyconvincedthatthechild’sarmiseitherbrokenordislocated.Weallrecognizethisasradialheadsubluxationor“nursemaid’selbow”andimmediatelyattempttoreduceit.Theprovidertakestheinjuredarm,supinatesatthewristandflexesattheelbow.Doesthechildscream?Whatifnothinghappens? Isthereanalternativetechniquetoreducinganursemaid’selbow?HyperpronationReductionTechniqueA2009paperbyBeketal describedamethodofpronationinsteadofsupination-flexion1.Theproposedmaneuverinvolvesonehandholdingtheelbowat90degreesofflexionandtheotherhandholdingthewrist.Thewrististhenhyperpronatedtocompletethereduction.Sixty-sixpatientswererandomizedtoeitheratraditionalsupinationreductionorthehyperpronationmaneuver.Iftheinitialattemptfailed,asecondattemptwasperformed.Ifthesecondattemptfailed,thenthealternatemethodwasperformed.Thebottom-lineresultwasthatthehyperpronationtechniquewas94%successfulonthefirstattempt,comparedtosupination-flexionat69%.Furthermore,threepatientsfailedthesupinationtechnique(firstandsecondattempt)butweresuccessfullyreducedwithhyperpronationonthefirstattempt.Hyperpronationwasalsosubjectivelyratedassignificantlyeasierthanthesupination-flexionbythepractitioner.ADVERTISEMENTTherewasalsoa2009Cochranereviewcomparingthesetworeductiontechniqueswh