Hyperpronation: This reduction technique for a nursemaid's elbow (radial head subluxation) has been found to have better first attempt success than classic supination/flexion technique. (Pediatrics July '98). Support the elbow with a finger on the radial head, and forcefully hyperpronate.
Technique may be less painful as well.
Reexamine after five minutes, and normal function should be returned
Xrays are generally unnecessary unless history and physical are not consistent with nursemaid's elbow, symptoms for greater than 12 hours, or reductions attempts are unsuccessful
Supination/Flexion may be attempted after two failed hyperpronation attempts
