Percutaneous K-wire pry-poking reposition and fixation for O'Brien II, III pediatric radial neck fracture

Abstract

Objective To evaluate the outcome of percutaneous K-wire leverage reduction and fixation for O'Brien II, III pediatric radial neck fracture. Methods From March 2010 to February 2013, 16 children with O'Brien II, III pediatric radial neck fracture were operated in our hospital. There were 6 females and 10 males aged from 6 to 14 years old. There were 12 left arms and 4 right arms. Concomitant injuries included proximal ulna fractures in 2 cases and medial epicondyle fracture of humerus in 1 case. All children present a swollen and painful elbow with loss of rotation and pain on pronation and supination. The mean visual analogue score (VAS) was 7.9 (range, 6.5-9.2). The flextion, extention, pronation and supination of elbow were 78°±3°, -54°± 4°, 9°±3° and 5°±3° in average. All cases were classified by the O'Brien system, including 9 cases of II type and 7 cases of III type. Mechanism of injury was fall from a height. The interval between injury and surgery averaged 2.8 days. Percutaneous lever-age reduction and fixation were performed for 16 patients. After confirming successful reduction, the wire was advanced to the far cortex of the radius and penetrated into the far cortex to maintain the reduction status. 4 weeks of longarm cast followed by functional exercises were carried out for all patients. We analyzed radiographs and clinical results according to the criteria suggested by Metaizeau. Results 16 patients were followed up for 11.8 month in average after operation. 14 patients were gained anatomical reduction. No patient had posterior interosseous nerve injury, fracture redisplacement and pin site infection. All fractures healed in a mean of 4.1 weeks. The followup flextion, extention, pronation and supination of elbow were 136°±4°, -2°±2°, 81°±4° and 75°±4°in average. Follow-up radiographs showed no patient had avascular necrosis of radial head. One patient had physeal arrest after 15 months of operation and outpatient followup observation were conducted. According to Metaizeau function scale, 8 were excellent, 7 good and 1 fair. The healing rate was 93.8% (15/16). Conclusion Percutaneous joystick reduction and fixation technique have good effect for O'Brien II, III pediatric radial neck fracture, which is simple and easy to master. Key words: Child; Radius fractures; Fracture fixation