YAJEM-56475; No of Pages 1

American Journal of Emergency Medicine xxx (2017) xxx

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American Journal of Emergency Medicine

journal homepage: www.elsevier.com/locate/ajem

Original Contribution

Nursemaid's elbow☆
Vincent Ndebwanimana, Amelia Y Pousson, Giles N Cattermole ⁎
Emergency Department, University of Rwanda, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda

a r t i c l e i n f o While the overall message that hyperpronation was more effective

than supination-flexion is true, we think it's important that the
Article history:
difference should not be exaggerated, and errors corrected.
Received 26 January 2017
Accepted 4 February 2017
Available online xxxx Faithfully yours,

Keywords: Dr Vincent Ndebwanimana, Dr Amelia Y Pousson, Dr Giles N

Pediatrics Cattermole. Emergency Department, Centre Hospitalier Universitaire de
Orthopedics Kigali, University of Rwanda.
Statistics

Dear editor,

Bexkens and colleagues have published a very helpful meta-analysis

of studies comparing the hyperpronation and supination-flexion
methods to treat nursemaid's elbow. Their paper was carefully studied
in the Rwandan Emergency Medicine residents' journal club, and we
agreed with their overall conclusions.
However, there appears to be a mistake in the calculation of the ab-
solute risk reduction (ARR), stated to be 26.4%, and the number needed
to treat (NNT), 3.8. In the supination-flexion group, the risk of failure on
first attempt was 96/351 (27%), and 32/350 (9%) in the hyperpronation
group. This is an ARR of 18% and NNT of 5.5.

☆ Bexkens R et al. Effectiveness of reduction maneuvers in the treatment of nursemaid's

elbow: A systematic review and meta-analysis. Am J Emerg Med 2017 Jan; 35(1): 159–163.
⁎ Corresponding author.
E-mail addresses: ndebwanimana@gmail.com (V. Ndebwanimana),
apousson@gmail.com (A.Y. Pousson), giles@cattermole.org.uk (G.N. Cattermole).

http://dx.doi.org/10.1016/j.ajem.2017.02.009
0735-6757/© 2017 Elsevier Inc. All rights reserved.

Please cite this article as: Ndebwanimana V, et al, Nursemaid's elbow, American Journal of Emergency Medicine (2017), http://dx.doi.org/
10.1016/j.ajem.2017.02.009