• Gökhan Aksel, Burak Küka, Mehmet Muzaffer İslam, Furkan Demirkapı, İlknur Öztürk, Oğuz Mete İşlek, Enis Ademoğlu, Serkan Emre Eroğlu, Merve Osoydan Satıcı, and Serdar Özdemir.
• University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey. Electronic address: aksel@gokhanaksel.com.
• Am J Emerg Med. 2024 Nov 18; 88: 293329-33.

ObjectiveThis randomized controlled trial aimed to compare the effectiveness of supination/flexion (SF) and hyperpronation (HP) maneuvers in the management of radial head subluxation (RHS) in children ≤6 years old presenting to the emergency department.MethodsPatients were randomly allocated to one of two treatment arms. Following the application of the respective reduction maneuver, maneuver success was assessed after 10 min. If unsuccessful, the maneuver was repeated up to three times. Patients failing to achieve reduction after three attempts were classified as experiencing ultimate failure. Treatment failure rates were compared between groups for each reduction attempt. Additionally, procedural pain, side effects, and recurrence within 72 h were compared between treatment groups.ResultsIn this study involving 119 patients, first attempt failure rates were 9.8 % in the HP group and 24.2 % in the SF group, indicating a statistically significant advantage for HP (Risk ratio 0.41 (95 % confidence interval 0.19 to 0.98)). No statistically significant differences were observed between groups regarding second-attempt success, ultimate failure, procedural pain, side effects, or recurrence rates within 72 h.ConclusionAmong children ≤6 years old presenting with RHS, the HP maneuver demonstrated significantly superior first-attempt success rates compared to SF. Therefore, we recommend the HP maneuver as the preferred initial treatment option for managing these patients.Gov RegistrationThe trial was registered on clinicaltrials.gov with registration number NCT05828641 (Url= https://classic.Clinicaltrialsgov/ct2/show/NCT05828641).Copyright © 2024. Published by Elsevier Inc.

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