Surgical management of displaced fractures neck of the radius in children: open reduction and temporary internal fixation in whom closed reduction has failed

Abstract

Introduction: Pediatric radial neck fractures account for 5 to 10% of all elbow fractures [1, 2]. The treatment of radial neck fractures in children varies according to the displacement, angulation, and skeletal maturity. Today open reduction is reserved for comminuted fractures and cases where closed reduction has failed. The purpose of this prospective study was to evaluate the outcome of open reduction and temporary internal fixation of pediatric radial neck fractures in whom initial closed reduction had failed. Materials and Methods: This study includes 15 children with fractures of the radial neck who were treated at our hospital between Sept 2009 and Oct 2014. Fractures were classified according to the classification system described by Judet et al. Inclusion criteria were: closed, displaced radial neck fracture with an angulation of more than 30º (Judet type & III & IV) in children with open growth plates (6-16 years) in whom closed method has failed. The patients are evaluated using MEPS score and radiograph at 2-3 month, 6 months. The patients were followed 11 to 40 months (average 18 months). The results were analysed using mean and SD deviation and ANOVA score. Results: 15 patients with radial neck fracture treated with ORIF with temporary extra articular k wiring Technique evaluated clinically (MEPS score) and radiologically (Post op neck angle). According to MEPS score 3(20%) had excellent results, 4(26.7%) had good outcomes and 8(53.4%) had fair to poor outcomes. Post op neck angle was excellent to good in 11(73.3%) patients and fair to poor in 4(26.7%) patients. Conclusion: In the management of paediatric radial neck fracture open reduction and internal fixation should be reserved for cases where for conservative methods have failed. Open reduction is associated with poor clinical outcomes.