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Joint Diseases and
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Case Report · Open access

Irreducible pulled elbow followed with supervised neglect and ultrasonography: Two case reports

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Masanori Wako

Department of Orthopaedic Surgery, National Hospital Organization Kofu National Hospital, Kofu, Japan

ORCID: 0000-0001-6311-7909

Tetsuhiro Hagino

Department of Orthopaedic Surgery, National Hospital Organization Kofu National Hospital, Kofu, Japan

ORCID: 0009-0000-5353-4477

Tetsuo Hagino

Department of Orthopaedic Surgery, National Hospital Organization Kofu National Hospital, Kofu, Japan

ORCID: 0000-0001-8669-2615

Jiro Ichikawa

Department of Orthopaedic Surgery, University of Yamanashi, Chuo, Japan

ORCID: 0000-0002-9850-6047

Hirotaka Haro

Department of Orthopaedic Surgery, University of Yamanashi, Chuo, Japan

ORCID: 0000-0002-5630-9600

Abstract

Pulled elbow (PE) is one of the most common upper limb injuries in children. The success rate of manipulation for PE ranges from 74 to 99%, with a favorable prognosis. However, the diagnosis of PE is often determined by the typical injury pattern, and there is a lack of diagnostic certainty. In recent years, ultrasonography has been used for the diagnosis of PE; however, it is still not a commonly used modality for the diagnosis. Moreover, manual reduction of PE is often difficult, and there is no consensus on the management of the elbow when the reduction maneuver fails. Further, it is unclear whether surgery or external immobilization is necessary. We followed two cases of irreducible PE with ultrasonography without aggressive treatment such as surgery or external immobilization. Both cases were initially irreducible, but spontaneous reduction was confirmed by ultrasonography seven days after injury in one case and nine days after injury in the other case. To the best of our knowledge, this is the first report of cases of irreducible PE in which the patients were carefully followed by ultrasonography without external immobilization or other intervention, and spontaneous resolution was confirmed. Although careful follow-up is necessary as ultrasonography may show no normalization in the radiocapitellar joint immediately after reduction, supervised neglect without external immobilization could be an optional treatment for irreducible PE and reduce unnecessary surgery.

Declarations

Author Contributions

Conceptualization, formal analysis, investigation, writing-original draft preparation: M.W.; Writing, reviewing, and editing: T.H., T.H., J.I.; Supervision, writing, reviewing, and editing: H.H.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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