Comparing two surgical methods for radial neck fractures in children: a Meta-analysis

Abstract

Objective To evaluate the clinical efficacies of closed reduction with elastic intramedullary nailing versus open reduction with Kirschner wire fixation for radial neck fractures in children. Methods The relevant databases were searched for comparative studies of closed reduction with elastic intramedullary nailing versus open reduction with Kirschner wire fixation for treating radial neck fractures in children. After extracting literature reports and quality evaluations, Rev Man 5.3 software was used for systematic review. Quality of post-operative fracture reduction, status of post-operative functional recovery of elbow joint, complications, fracture re-displacement after fixation removal, skin irritation, radial nerve injury and early closure of radial bone epiphysis were analyzed. Results A total of 9 literature reports were included for this Meta-analysis. For treating radial neck fractures in children, no significant inter-group difference existed in quality of post-operative fracture reduction [RR=0.98, 95%CI(0.86, 1.11), P=0.72]; complications[RR=0.61, 95%CI(0.24, 1.60), P=0.32]; skin irritation [RR=0.08, 95%CI(0.00, 1.40), P<0.08]; radial nerve injury [RR=1.22, 95%CI(0.13, 11.20), P<0.86]; early closure of radial bone epiphysis [RR=0.20, 95%CI(0.02, 1.64), P=0.13]. Additional articles were required for assessing the rate of fracture re-displacement after fixation removal. The results of Meta-analysis showed that closed reduction group was superior to open reduction group in status of post-operative functional recovery of elbow joint after treatment [RR=0.28, 95%CI (0.16, 0.52), P<0.0001]. Conclusions Closed reduction with elastic intramedullary nailing is superior to open reduction with Kirschner wire fixation in treating radial neck fractures in children. However, it offers no advantage of preventing complications. And larger sample size, double-blind and high-quality randomized controlled trials are warranted for confirming the results. Key words: Radial neck fracture; Nailing, intramedullary; Kirschner wires; Meta-analysis