Better Fixation In Severely Displaced Fracture

Abstract

Introduction:Fractures of the radial neck are relatively uncommon injuries; the incidence in children is reported to be about 1% of all pediatric fractures and 5% of elbow fractures in children. The radial head may be displaced in any direction, but the most common direction is lateral. Associated injuries may signify a more severe trauma to the elbow.Report:16 years old boy presented with alleged fall during playing football. Patient slipped during game due to slippery grass. Patient fall with elbow hit the ground. Post trauma complain left elbow swelling, pain and limited range of movement (ROM). X-ray and CT Scan elbow done noted radial neck fracture, completed displacement. Judet classification type IVa. Operation closed manipulative reduction (CMR) and titanium elastic nail system (TENS) performed for this patient. Intraoperatively in view of delayed operation soft callus formed already and make the CMR difficult. Initially we planned to do Metaizeau technique to reduce the fracture but in view of soft callus formation we have to performed Kapanji technique also to release the soft callus formation. Anatomical reduction achieved. Then patient upper limb protected with above elbow backslab for 1 month.Figure 1:Figure 2:Discussions:Treatment of radial neck fracture in adolescenthave to be planned properly. A lot of factor will contribute to final outcome of the injury including age of patient, grade of injury and etc. DE Mattos et al 2016 reported that older patient is more likely to have more severe displacement radial neck fracture requiring open reduction operation. Kaise M et al 2016 reported that the outcome of radial neck fracture appear to be related to severity of displacement rather than surgical manipulation. Metaizeau technique is widely used and recommended. Al-Aubaidi Z et al 2012 say that Metaizeau technique is excellent treatment and patient undergone open reduction had inferior outcome.Conclusion:Radial neck fracture is uncommon injury in children and severity of injury is important indicator for prognosis. Even though older patient and more severe injury can lead to poor outcome. Closed reduction still more favorable than open reduction in managing the fracture