Aksel Gökhan, Küka Burak, İslam Mehmet Muzaffer, Demirkapı Furkan, Öztürk İlknur, İşlek Oğuz Mete, Ademoğlu Enis, Eroğlu Serkan Emre, Satıcı Merve Osoydan, Özdemir Serdar
University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey.
University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey.
Am J Emerg Med. 2025 Feb;88:29-33. doi: 10.1016/j.ajem.2024.11.026. Epub 2024 Nov 18.
This 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.
Patients 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.
In 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.
Among 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.
The trial was registered on clinicaltrials.gov with registration number NCT05828641 (Url= https://classic.
gov/ct2/show/NCT05828641).
本随机对照试验旨在比较旋后/屈曲（SF）手法与旋前过度（HP）手法在急诊科就诊的6岁及以下儿童桡骨头半脱位（RHS）治疗中的有效性。
将患者随机分配至两个治疗组之一。在应用相应的复位手法后，10分钟后评估手法复位是否成功。若未成功，该手法可重复进行多达3次。三次尝试后仍未复位成功的患者被归类为最终失败。比较每组每次复位尝试的治疗失败率。此外，还比较了治疗组之间的操作疼痛、副作用以及72小时内的复发情况。
在这项涉及119名患者的研究中，HP组首次尝试失败率为9.8%，SF组为24.2%，表明HP具有统计学上的显著优势（风险比0.41（95%置信区间0.19至0.98））。在第二次尝试成功、最终失败、操作疼痛、副作用或72小时内的复发率方面，两组之间未观察到统计学上的显著差异。
在患有RHS的6岁及以下儿童中，与SF相比，HP手法首次尝试成功率显著更高。因此，我们建议将HP手法作为治疗这些患者的首选初始治疗方案。
该试验已在clinicaltrials.gov上注册，注册号为NCT05828641（网址 = https://classic.
gov/ct2/show/NCT05828641）。
