FIGURE 121.16 A–C: Hyperpronation maneuver for reduction of annular ligament displacement (nursemaid’s elbow) Return of function after successful reduction is usually prompt, but not immediate Toys, bottles, or interesting objects can be used to encourage the child to use the affected arm Voluntary use of the arm will return in less than 15 minutes in almost 90% of patients Younger children generally take longer to begin reusing the arm Longer duration of ALD does not appear to be associated with delayed return of function Many clinicians relate experiences with “failed” reductions in children whose arms are better the following morning If disuse of the arm persists and radiographs are normal, a sling should be placed and the child should be seen in follow-up by an orthopedist Recurrent ALDs are common, occurring in a quarter to one-third of cases Caregivers should be counseled to lift the child from the axillae, avoiding traction on the distal extremities Shoulder (Glenohumeral) Subluxation/Dislocation Shoulder dislocation is extremely uncommon in young children Shoulder dystocia at delivery can lead to displaced Salter I fractures that look like dislocations because the unossified proximal humeral epiphysis remaining in the glenoid fossa is not visible radiographically True dislocations become more