How is supination-flexion reduction of a radial head subluxation performed?

Updated: Apr 08, 2020
  • Author: Gretchen S Lent, MD; Chief Editor: Erik D Schraga, MD  more...
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Answer

The supination-flexion technique (see the image below) is the classic method of reducing a subluxated radial head. It has a success rate of 80-92%.

Reduction of subluxated radial head: supination-fl Reduction of subluxated radial head: supination-flexion. Technique begins with supination, followed by full flexion at elbow.

The procedure begins with the patient’s arm in pronation and elbow in 90° of flexion, with pressure applied over the patient’s radial head (see the images below).

Reduction of subluxated radial head: supination-fl Reduction of subluxated radial head: supination-flexion. Technique begins with elbow flexed.
Reduction of subluxated radial head. Shortly after Reduction of subluxated radial head. Shortly after reduction, child resumes using affected arm.

Next, the wrist is firmly supinated, with pressure maintained on the radial head (see the images below).

Reduction of subluxated radial head: supination-fl Reduction of subluxated radial head: supination-flexion. Wrist is supinated with elbow still in 90° of flexion.
Reduction of subluxated radial head: supination-fl Reduction of subluxated radial head: supination-flexion. During supination, pressure is maintained on radial head.

The patient’s elbow is then completely flexed (see the images and videos below). A click is often felt over the radial head (or heard) when the arm has reached full flexion. A palpable or audible click is associated with a high probability of successful reduction.

Reduction of subluxated radial head: supination-fl Reduction of subluxated radial head: supination-flexion. After supination, elbow is fully flexed.
Reduction of subluxated radial head: supination-fl Reduction of subluxated radial head: supination-flexion. With one hand supinating wrist, other thumb feels click as radial head falls into place on full flexion.
Reduction of subluxated radial head: supination-flexion. Side view of technique.
Reduction of subluxated radial head: supination-flexion. Front view of technique.

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