幼児の肘内障の徒手整復法
Appendices
Appendix 1. Search strategies for this update (2011 to September 2016)
CENTRAL (Wiley Online Library)
#1 MeSH descriptor: [Elbow Joint] this term only (231)
#2 MeSH descriptor: [Elbow] this term only (164)
#3 elbow:ti,ab,kw (1970)
#4 radial or radius:ti,ab,kw AND head or distal:ti,ab,kw (1077)
#5 #1 or #2 or #3 or #4 (2976)
#6 MeSH descriptor: [Dislocations] this term only (249)
#7 dislocate* or slipped or pulled or sublux* or "internal derangement" or "painful pronation" or "�nternally deranged":ti,ab,kw (542)
#8 #6 or #7 (741)
#9 #5 and #8 (52)
#10 "Goyrand's injury" or "Malaigne's luxation" or "nursemaid's elbow" or "Babysitter's elbow" or "Temper tantrum elbow" or "Sunday afternoon arm" or "Gromeyer's injury" or "curbstone fracture" or "supermarket elbow" or "pronatio dolorosa infantum" or "annular ligament displacement":ti,ab,kw (5)
#11 #9 or #10 (53)
#12 MeSH descriptor: [Child] explode all trees (192)
#13 MeSH descriptor: [Infant] explode all trees (14574)
#14 MeSH descriptor: [Pediatrics] explode all trees (631)
#15 MeSH descriptor: [Adolescent] explode all trees (86589)
#16 Child* or infant* or pediatric* or paediatric* or toddler* or adolescent*:ti,ab,kw (183988)
#17 #12 or #13 or #14 or #15 or #16 (183999)
#18 #11 and #17 (29)
MEDLINE (Ovid Online)
1 Elbow/ or Elbow Joint/ (16286)
2 elbow.tw. (25196)
3 ((radial or radius) and (head or distal)).tw. (16595)
4 1 or 2 or 3 (44533)
5 Dislocations/ (23028)
6 (dislocate* or slipped or pulled or sublux* or internal derangement or painful pronation or internally deranged).tw. (23546)
7 5 or 6 (42780)
8 4 and 7 (3427)
9 (Goyrand* injury or Malaigne* luxation or nursemaid* elbow or Babysitter* elbow or Temper tantrum elbow or Sunday afternoon arm or Gromeyer* injury or curbstone fracture or supermarket elbow or pronatio dolorosa infantum or annular ligament displacement).tw. (42)
10 8 or 9 (3432)
11 exp Child/ or exp Infant/ or exp Pediatrics/ or Adolescent/ (3173635)
12 (child* or infant* or pediatric* or paediatric* or toddler* or adolescent*).tw. (1620321)
13 11 or 12 (3538238)
14 10 and 13 (1654)
15 Randomized controlled trial.pt. (429552)
16 Controlled clinical trial.pt. (91634)
17 randomized.ab. (368786)
18 placebo.ab. (178430)
19 Drug therapy.fs. (1902478)
20 randomly.ab. (262645)
21 trial.ab. (383644)
22 groups.ab. (1634679)
23 or/15‐22 (3891094)
24 exp Animals/ not Humans/ (4306043)
25 23 not 24 (3356638)
26 14 and 25 (92)
27 (201110* or 201111* or 201112* or 2012* or 2013* or 2014* or 2015* or 2016*).ed,dc. (6001473)
28 26 and 27 (24)
Embase (Ovid Online)
1 Elbow Dislocation/ (1134)
2 Elbow/ or Elbow Injury/ (17234)
3 elbow.tw. (29252)
4 ((radial or radius) and (head or distal)).tw. (18996)
5 2 or 3 or 4 (50919)
6 Dislocation/ or Subluxation/ (15569)
7 (dislocate* or slipped or pulled or sublux* or internal derangement or painful pronation or internally deranged).tw. (26084)
8 6 or 7 (37869)
9 5 and 8 (2331)
10 1 or 9 (3289)
11 (Goyrand* injury or Malaigne* luxation or nursemaid* elbow or Babysitter* elbow or Temper tantrum elbow or Sunday afternoon arm or Gromeyer* injury or curbstone fracture or supermarket elbow or pronatio dolorosa infantum or annular ligament displacement).tw. (49)
12 10 or 11 (3301)
13 exp Child/ or Pediatrics/ or Adolescent/ (2971604)
14 (child* or infant* or pediatric* or paediatric* or toddler* or adolescent*).tw. (1895817)
15 13 or 14 (3467151)
16 12 and 15 (1295)
17 Randomized controlled trial/ (416151)
18 Clinical trial/ (866278)
19 Controlled clinical trial/ (397539)
20 Randomization/ (71772)
21 Single blind procedure/ (22979)
22 Double blind procedure/ (131292)
23 Crossover procedure/ (48506)
24 Placebo/ (280258)
25 Prospective Study/ (349547)
26 ((clinical or controlled or comparative or placebo or prospective$ or randomi#ed) adj3 (trial or study)).tw. (941011)
27 (random* adj7 (allocat* or allot* or assign* or basis* or divid* or order*)).tw. (232779)
28 ((singl* or doubl* or trebl* or tripl*) adj7 (blind* or mask*)).tw. (188971)
29 (cross?over* or (cross adj1 over*)).tw. (81782)
30 ((allocat* or allot* or assign* or divid*) adj3 (condition* or experiment* or intervention* or treatment* or therap* or control* or group*)).tw. (310004)
31 RCT.tw. (21407)
32 or/17‐31 (2259319)
33 Case Study/ or Abstract Report/ or Letter/ (1011357)
34 32 not 33 (2216645)
35 16 and 34 (86)
36 (2011* or 2012* or 2013* or 2014* or 2015* or 2016*).em,dd. (8903742)
37 35 and 36 (30)
CINAHL (EBSCO)
S1 (MH "Elbow Dislocation") (131)
S2 (MH "Elbow") OR (MH "Elbow Joint") (3,417)
S3 TX ( radial or radius ) or TX ( head or distal ) (116,800)
S4 S2 or S3 (119,543)
S5 TX dislocate* or slipped or pulled or sublux* or “internal derangement” or “painful pronation” or "internally deranged" (5,464)
S6 S4 and S5 (846)
S7 TX “Goyrand’s injury” or “Malaigne’s luxation” or "nursemaid's elbow" or “Babysitter’s elbow” or “Temper tantrum elbow” or “Sunday afternoon arm” or “Gromeyer’s injury” or “curbstone fracture” or “supermarket elbow” or “pronatio dolorosa infantum” or "annular ligament displacement" (22)
S8 S1 or S6 or S7 (977)
S9 (MH "Child") (321,571)
S10 (MH "Infant") (121,054)
S11 (MH "Pediatrics") (13,431)
S12 (MH "Adolescence") (360,897)
S13 TX child* OR infant* OR pediatric* OR paediatric* OR toddler* OR adolescent* (934,476)
S14 S9 or S10 or S11 or S12 or S13 (934,489)
S15 S8 and S14 (448)
S16 (MH "Clinical Trials+") (202,246)
S17 (MH "Evaluation Research+") (29,704)
S18 (MH "Comparative Studies") (91,730)
S19 (MH "Crossover Design") (13,919)
S20 PT Clinical Trial (79,712)
S21 (MH "Random Assignment") (41,528)
S22 S16 or S17 or S18 or S19 or S20 or S21 (319,977)
S23 TX ((clinical or controlled or comparative or placebo or prospective or randomi?ed) and (trial or study)) (925,857)
S24 TX (random* and (allocat* or allot* or assign* or basis* or divid* or order*)) (83,103)
S25 TX ((singl* or doubl* or trebl* or tripl*) and (blind* or mask*)) (870,042)
S26 TX ( crossover* or 'cross over' ) or TX cross n1 over (18,248)
S27 TX ((allocat* or allot* or assign* or divid*) and (condition* or experiment* or intervention* or treatment* or therap* or control* or group*)) (109,735)
S28 S23 or S24 or S25 or S26 or S27 (1,635,889)
S29 S22 or S28 (1,645,773)
S30 S15 and S29 (239)
S31 EM 2011 OR EM 2012 OR EM 2013 OR EM 2014 OR EM 2015 OR EM 2016 (2,007,802)
S32 S30 AND S31 (91)
LILACS
((Mh Elbow Joint or Mh Elbow or Tw elbow or ((Tw radial or Tw radius) and (Tw head or Tw distal))) and (Mh Dislocations or Tw dislocate$ or Tw slipped or Tw pulled or Tw sublux$ or Tw internal derangement or Tw painful pronation or Tw ïnternally deranged)) or (Tw Goyrand’s injury or Tw Malaigne’s luxation or Tw nursemaid's elbow or Tw Babysitter’s elbow or Tw Temper tantrum elbow or Tw Sunday afternoon arm or Tw Gromeyer’s injury or Tw curbstone fracture or Tw supermarket elbow or Tw pronatio dolorosa infantum or Tw annular ligament displacement) or ((Mh Codo or Tw Codo or Mh Articulação do Cotovelo) and (Tw dislocaci$ OR Tw subluxaci$)) or ((Mh Cotovelo or tw Cotovelo or Mh Articulação do Cotovelo) and (Tw disloca$ or Tw subluxaç$))[Palavras]
And
(Mh Child or Mh Infant or Mh Pediatrics or Mh Adolescent or Tw child$ or Tw infant$ or Tw pediatric$ or Tw paediatric$ or Tw toddler$ or Tw adolescent$) [Palavras]
And
((Pt Randomized controlled trial or Pt Controlled clinical trial or Mh Randomized controlled trials or Mh random allocation or Mh double‐blind method or Mh single‐blind method or Pt Multicenter study) or ((Tw ensaio or Tw ensayo or Tw trial) and (Tw azar or Tw acaso or Tw placebo or Tw control$ or Tw aleat$ or Tw random$ or (Tw duplo and Tw cego) or (Tw doble and Tw ciego) or (Tw double and Tw blind)) and Tw clinic$)) and not ((Ct animals or Mh animals or Ct rabbits or Ct mice or Mh rats or Mh primates or Mh dogs or Mh rabbits or Mh swine) and not (Ct human and Ct animals)) [Palavras]
Total = 0
PEDro
Advanced search
Abstract & Title: Dislocate/slipped/ pulled/ sublux/ internal derangement/ painful pronation/ ïnternally deranged/
Body part: forearm or elbow
Method: clinical trial
New records added since: 01/07/2011
Total = 0
Simple search
-
Radial head (12)
-
Pulled elbow (2)
ISRCTN Registry
-
elbow and pulled (2)
-
elbow and dislocate* (0)
-
elbow and sublux* (0)
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elbow and pronation (2)
-
radial and head and pulled (0)
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radial and head and sublux* (0)
-
radial and head and dislocat* (0)
WHO ICTRP
-
Elbow AND dislocate* OR Elbow AND slipped OR Elbow AND pulled OR Elbow AND sublux* OR Elbow AND derange* OR Elbow AND pronation (8)
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Radial AND head AND dislocate* OR Radial AND head AND slipped OR Radial AND head AND pulled OR Radial AND head AND sublux* OR Radial AND head AND derange* OR Radial AND head AND pronation (1)
ClinicalTrials.gov
-
elbow AND (dislocate OR slipped OR pulled OR subluxation OR derangement OR pronation OR deranged) (30)
-
radial AND head AND (dislocate OR slipped OR pulled OR subluxation OR derangement OR pronation OR deranged) (3)
Appendix 2. Reports of search results in previous versions of the review
First version: 2009, Issue 4 (Date of search: January 2009)
The numbers of records identified via our searches of individual databases for the first version of the review were as follows: Cochrane Central Register of Controlled Trials (19 records), PubMed (21 records), EMBASE (57 records), CINAHL (15 records), LILACS (no records) and PEDro (no records). After removing duplicates and screening of titles and abstracts, together with references provided from the Specialised Register of the Cochrane Bone, Joint and Muscle Trauma Group, we identified five potentially eligible studies. Of these, four were published in full and one was a conference abstract. Upon study selection, three studies (Green 2006; Macias 1998; McDonald 1999) were included, one was excluded (Taha 2000) and one, only reported as a conference abstract, awaited classification (Vidosavljevic 2006).
Second version: 2012, Issue 1 (Date of search: July 2011)
For this update (July 2011), we screened a total of 68 records from the following databases: Specialised Register of the Cochrane Bone, Joint and Muscle Trauma Group (one record), Cochrane Central Register of Controlled Trials (21 records), MEDLINE (five records), EMBASE (seven records), CINAHL (31 records), LILACS (no records), PEDro (two records) and The WHO International Clinical Trials Registry Platform (one record). The results from the previous searches (up to January 2009) are shown in Appendix 2.
The search update resulted in the identification of two potentially eligible studies. Upon study selection, one was included (Bek 2009) and the other placed in 'Ongoing studies' (NCT00993954).
Overall, there are now four included trials (Bek 2009; Green 2006; Macias 1998; McDonald 1999), one excluded study (Taha 2000), one ongoing trial (NCT00993954), and one study, which was only reported as a conference abstract, continued to await classification (Vidosavljevic 2006)
Study flow diagram
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Forest plot of comparison: 1 Pronation versus supination, outcome: 1.1 Failure: second attempt required.
Comparison 1 Pronation versus supination, Outcome 1 Failure: second attempt required.
Comparison 1 Pronation versus supination, Outcome 2 Failure: continued failure after second attempt with same procedure.
Comparison 2 Supination and extension versus supination then flexion, Outcome 1 Failure: second attempt required.
| Pronation compared with supination reduction techniques for pulled elbow in young children | ||||||
| Patient or population: Children with pulled elbow1 Settings: Emergency departments, ambulatory care centres or orthopaedic units Intervention: Pronation (all were hyperpronation) for first manipulation Comparison: Supination (all included flexion) for first manipulation | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Supination‐flexion | Hyperpronation | |||||
| Failure: second attempt required | 268 per 10002 | 94 per 1000 (67 to 134) | RR 0.35 (0.25 to 0.50) | 811 | ⊕⊕⊝⊝ | |
| Pain (preferably during the procedure) | see Comments | see Comments | see Comments | ⊕⊝⊝⊝ | Data for this outcome are incomplete and were measured in very different ways in four studies. | |
| Adverse effects (e.g. bruising) | see Comments | see Comments | None of the trials reported this outcome. | |||
| Failure: continued failure after second attempt using same procedure as before | 147 per 10002 | 24 per 1000 | RR 0.16 (0.09 to 0.32) | 624 | ⊕⊝⊝⊝ | This outcome represented the cumulative effect of two manipulations using hyperpronation versus cumulative effect of two manipulations using supination‐flexion. Reassuringly, both procedures when used again resulted in further successful reductions; these were proportionally greater with hyperpronation (64% versus 28%). However, the second attempt should not be considered independently of the first attempt and the characteristics of the children requiring a second attempt may have differed in important ways between the two groups. |
| Ultimate failure | see Comments | see Comments | Although potentially influenced by the initial (allocated) method of manipulation, this outcome reflected various manipulation protocols that stipulated the choice of method used for subsequent attempts. Overall failure at the end of the protocol ranged from 0 to 6 (4.1% of 148 episodes). | |||
| Recurrence (within one month) | see Comments | see Comments | None of the trials reported this outcome. | |||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1. Young children: typically aged under 7 years; mean age around 2 years. 2. Median control group (supination‐flexion) risk across studies 3. Evidence downgraded two levels for very serious risk of bias (selection and detection biases). 4. Evidence downgraded two levels for very serious risk of bias (selection, detection and incomplete outcome biases) and one level for inconsistency (two of the studies reported in favour of pronation, whereas two studies reported no difference between the procedures) 5. Evidence downgraded two levels for very serious risk of bias (and one level for imprecision (there were just 9 events in the hyperpronation group) | ||||||
| Radial head subluxation |
| Partial dislocation of the radial head peculiar to children |
| Dislocation of the head of the radius by elongation |
| Annular ligament displacement |
| Partial epiphyseal separation of the radial head |
| Anterior isolated subluxation of the radial head |
| Internal derangement of the elbow |
| Slipped elbow of young children |
| Painful elongation of young children |
| Painful paralysis in young children |
| Rotation syndrome |
| Painful pronation |
| Tamper tantrum elbow |
| Elbow sprain |
| Goyrands’s injury |
| Malaigne’s luxation |
| Gromeyer’s injury |
| Pronatio dolorosa infantum (Chassaignac) |
| Curbstone fracture |
| Supermarket elbow |
| Sunday (afternoon) arm |
| Housemaid’s elbow |
| Nursemaid’s elbow |
| Babysitter’s elbow |
| Sensitivity analysis | Results | NNT |
| Removal of quasi‐RCTs | RR 0.47, 95% CI 0.30 to 0.73; 370 participants; I2 = 13% | 8, 95% CI 5 to 17 |
| Removal of Green 2006 (baseline imbalance) | RR 0.34, 95% CI 0.24 to 0.49; 739 participants; I2 = 35% | 6, 95% CI 5 to 8 |
| Removal of 17 participants with prior manipulation in Garcia‐Mata 2014) | RR 0.35, 95% CI 0.24 to 0.50; 794 participants; I2 = 28% | 7, 95% CI 5 to 10 |
| Study | Outcome definition | Overall no. of failures / no. episodes | Protocol |
| Failure after 4 attempts | Not reported | 4 attempts, cross‐over on 3rd attempt | |
| Failure after 3 attempts | 0 / 66 (0%) | 3 attempts, cross‐over on 3rd attempt | |
| Failure after 3 attempts | 3 / 115 (2.6%) | 3 attempts, cross‐over on 2rd attempt original method for 3rd attempt | |
| Failure after 2 attempts | 2 / 75 (2.7%) | 2 attempts, cross‐over on 2nd attempt | |
| Failure after 3 attempts | 0 / 150 (0%) | 3 attempts, cross‐over on 3rd attempt | |
| Failure after 3 attempts | Not reported | 3 attempts, cross‐over on 3rd attempt | |
| Failure after 4 attempts | 1 / 90 (1.1%) | 4 attempts, cross‐over on 3rd attempt order same for 4th attempt | |
| Failure after 3 attempts | 6 / 148 (4.1%) | 3 attempts, cross‐over on 3rd attempt |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Failure: second attempt required Show forest plot | 8 | 811 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.35 [0.25, 0.50] |
| 2 Failure: continued failure after second attempt with same procedure Show forest plot | 6 | 624 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.16 [0.09, 0.32] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Failure: second attempt required Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
