Percutaneous haemostat stroke-poking reduction and elastic intramedullary nailing for pediatric radial neck fractures

Abstract

Objective To evaluate the clinical efficacy of percutaneous haemostat stroke-poking re-duction and elastic intramedullary nailing for pediatric radial neck fractures of O’Brien types Ⅱ & Ⅲ. Methods From January 2014 to June 2016, 38 children (23 boys and 15 girls) with radial neck fracture of O’Brien type Ⅱ or Ⅲ were treated by percutaneous haemostat stroke-poking reduction and elastic intramedullary nailing in our department. We had 26 left and 12 right sides. Their ages ranged from 5 to 14 years, averaging 8.6 years. All fractures were fresh. According to O＇Brien classification, 22 cases were type Ⅱ and 16 type Ⅲ. The oper-ation time, frequency of intraoperative C-arm fluoroscopy, frequency of percutaneous haemostat stroke-poking reduction, and union time were recorded. The elbow function was assessed one day before removal of internal implants according to the Metaizeau scoring system. Results All operations succeeded, lasting from 12 to 25 min (average, 16.4 min). The frequency of intraoperative fluoroscopy ranged from 3 to 11 times (average, 6.4 times); the frequency of intraoperative percutaneous reduction ranged from 1 to 4 times (average, 2.3 times). The patients were followed up for 6 to 22 months (average, 11.2 months). Postoperative X-ray films showed satisfactory alignment of the fracture ends. All fractures demonstrated clinical and radiographic evi-dence of complete healing after a mean time of 58 days (from 38 to 72 days). The Metaizeau scoring showed 33 excellent, 4 good and one fair cases, yielding an excellent to good rate of 97.4%. Follow-ups revealed no in-fection, implants breakage, nonunion, fracture redisplacement, or iatrogenic radial nerve injury. Conclusions As percutaneous haemostat stroke-poking reduction can increase the probability of successful re-duction at first attempt, reduce frequency of close reduction and X-ray exposure for both children and medical staff, and shorten operation time, the procedure is effective, simple, reliable and minimally invasive, leading to fewer complications. Key words: Radius fractures; Fracture fixation,intramedullary; Child