CONTEXT: Radial head subluxation, also known as 'pulled elbow', 'dislocated 
elbow' or 'nursemaid's elbow', is one of the most common upper extremity 
injuries in young children and a common reason to visit Emergency Department 
(ED).
AIM: To compare supination of the wrist followed by flexion of the elbow (the 
traditional reduction technique) to hyperpronation of the wrist in the reduction 
of radial head subluxations (nursemaid's elbow) maneuvers in children presented 
to ED with painful pronation and to determine which method is less painful by 
children.
SETTINGS AND DESIGN: This prospective randomize study involved a consecutive 
sampling of children between 1-5 year old who were presented to the ED with 
painful pronation.
MATERIALS AND METHODS: The initial procedure was repeated if baseline 
functioning did not return 20 minutes after the initial reduction attempt. 
Failure of that technique 30 minutes after the initial reduction attempt 
resulted in a cross-over to the alternate method of reduction.
STATISTICAL ANALYSIS USED: Datas were analyzed using SPSS for Windows 16.0. 
Mean, standard deviation, independent samples t test, Chi-square test, and 
paired t test were used in the assessment of pain scores before and after 
reduction.
RESULTS: When pain scores before and after reduction were compared between 
groups to determine which technique is less painful by children, no significant 
difference was found between groups.
CONCLUSIONS: It was found that in the reduction of radial head subluxations, the 
hyperpronation technique is more effective in children who were presented to ED 
with painful pronation compared with supination-flexion. However, there was no 
significant difference between these techniques in terms of pain.