Percutaneous Reduction and Fixation Using Two K-wires In Paediatric Angulated Radial Neck Fractures.

Abstract

Fractures of the radial neck in children are usually seen at about the age of five years, after the appearance of the proximal radial epiphysis. They are usually caused by a fall on the outstretched hand which produces a valgus strain [1]. Minor degrees of angulation can be accepted and treated conservatively, but advice on the maximum acceptable angulation varies widely, up to as much as 45°0 [2] More severely angulated and displaced fractures have been variously treated by closed or open reduction, but the precise indications for each are not clear [3]. In a retrospective study Steele et al. found that open reduction generally had a poor result and that open reduction with internal fixation was even worse, as has been reported by others [4, 5]. We describe a modified percutaneous technique using two (1.6mm) K-wires for reduction (one wire for leverage and one wire for translation) and two K-wires for rotationally stable fixation. Nine patients were included in the study. The median age of the patients was 9.6years. There were six males and three females. The average follow up period was 23months. The final results of the study included six patients with excellent results and one with a good result. Unfortunately, two patients were visitors and failed to attend for review. We have found this technique effective and easily reproducible. Level of evidence IV - Case series.