Elastic-stable intramedullary nailing for radial neck fractures in children: clinical and radiological outcomes and risks for poor prognosis

Abstract

Introduction. Radial neck fractures in children are rare and account for 1-3% of all childhood trauma. Severe displacement of the fracture can lead to a higher incidence of complications, such as limited range of motion (ROM ), pain, instability, neurovascular trauma, premature physeal closure, cubitus valgus, radial head overgrowth, avascular necrosis and improper ossification. The treatment outcome depends on the injury type, treatment method and presence of complications. Aim. The purpose of the study was to assess the outcome of patients treated with elastic-stable intramedullary nailing (ESIN) regarding different radial head angulations and to search for risk factors of a poor outcome. Materials and methods. Twenty-six consecutive patients treated between October 2020, and March 2022, due to radial neck fracture were included in the study. Closed reduction and ESIN fixation were performed. If failed, A K-wire assisted reduction or open reduction was performed. A radiological evaluation was performed pre- and post surgery and at the last follow-up. At the last follow-up visit, the elbow range of motion (ROM ) was measured and the Mayo Elbow Performance Score (MEPS) was established. The followup was after 25 months. Results. The angulation before surgery was 42.4° and the next day after surgery was 6.9°, p = 0.0001. Further correction was observed and at the last follow-up it was 2.5°, p = 0.001. We found no complications besides one skin irritation by an implant and 2 reduced ROM . The MEPS was 97.7. The difference in MEPS between Judet IVB (angulation before surgery> 80°) 92.5 and other patients 98.6 was significant, p = 0.04674. There was no significant difference in MEPS, ROM , between patients immobilized in a plater cast versus in a sling, Conclusions. Closed reduction with the use of ESIN can be considered a safe procedure with a low rate of complications. Patients with an angulation >80° revealed worse functional effects. Cast immobilization did not reveal a negative or a positive impact on the treatment result.