BACKGROUND/AIM: Nursemaid's elbow usually occurs in young children when 
longitudinal traction is placed on the arm. Several manipulative maneuvers have 
been described, although, the most effective treatment technique is yet unclear. 
The aim of this systematic review and meta-analysis was to compare the two most 
commonly performed maneuvers (supination-flexion and hyperpronation) in the 
treatment of nursemaid's elbow.
METHODS: A literature search was performed in PubMed, Embase, and Cochrane 
databases to identify randomized controlled trials comparing supination-flexion 
and hyperpronation. Data were extracted and pooled independently by two authors. 
Methodological quality assessment of included studies was performed. 
Meta-analysis was performed using a fixed-effect model in case of homogeneity 
across studies, and using a random-effect model in case of heterogeneity. 
Heterogeneity was calculated with the χ2 test and inconsistency in study effects 
across trials was quantified by I2 values.
RESULTS: Seven randomized trials, including 701 patients (62% female), were 
included. A total of 350 patients were treated with the hyperpronation maneuver 
versus 351 patients who underwent the supination-flexion maneuver. Meta-analysis 
showed that hyperpronation was more effective than supination-flexion (risk 
ratio, 0.34; 95% confidence interval, 0.23 to 0.49; I2, 35%). The absolute risk 
difference between maneuvers was 26% in favor of hyperpronation, resulting in a 
number needed to treat of 4 patients. Trials lacked blinding of assessors and 
universal pain measures.
CONCLUSIONS: Hyperpronation was more effective in terms of success rate and 
seems to be less painful compared to the supination-flexion maneuver in children 
with nursemaid's elbow.