Pulled elbow: Diagnosis and management, the Paraguay experience

Abstract

Objectives: The objectives of the study were to show the Paraguay experience in the diagnosis and handling of pulled elbows in recent years. Methods: A retrospective study of patients who presented to the emergency service was carried out from July 2019 to December 2021. Patients under 6 years with typical symptoms and signs of pulled elbow were included in the study. The data collected were demographics, affected side, mechanism of injury, and number of times pulled elbow occurred. The maneuver performed for the treatment and its success was also recorded. Results: There were 30 pulled elbow cases in 26 patients. Age ranged from 1 to 5 years, with a median of 3 years. The left side was more frequently affected (53%). There were more females affected (77%). The main mechanism of injury was upper limb traction, which occurred in 26 elbows (86.6%), followed by falling from a standing height in four cases. We found that imaging studies are requested when the reason for consultation is referred to as a possible fall from one’s own height. The hyperpronation method of reduction was effective in all cases. The treating physician felt the “click” in 93.3% of the times. Conclusion: The pulled elbow is a frequent injury in pediatric emergencies. It requires a high index of suspicion to make the diagnosis and a training to perform the hyperpronation reduction maneuver. Physicians subjected to the diagnosis and reduction maneuver training, can treat these injuries successfully without consultation of pediatric orthopedics.