Treatment of radial neck fractures in children

Abstract

Objective To summarize the results of treatment of radial neck fractures of O'Brien type Ⅱ and Ⅲ in children by close intramedullary pinning (CIMP) and percutaneous Kirshner's wire leverage (PKWL).Methods From Jun.2006 to Aug.2010,17 cases of radial neck fractures of O'Brien type Ⅱ and Ⅲ in children were treated.Among them,8 were male and 9 were female,with a mean age of 9.7 years.There were 13 left arms and 4 right arms.The interval between the injury and surgery averaged 4.6 days.Concomitant injuries included proximal ulna fractures in 2 cases,medial epicondyle fracture of humerus in one case,elbow dislocation in another.PKWL and CIMP were conducted individually or in combination to effect fracture reduction.3 weeks of long-arm cast followed by functional exercises were carried out as follow-on treatment.Results Of the 17 cases,16 had close reduction (4 by PKWL and 12 by CIMP).The remaining one who had a completely displaced fracture resulted from dislocation was openly reduced and fixed with K-wires.Of the two concomitant proximal ulna fracture,one was treated conservatively and the other was openly reduced and internally fixed.This was the same for displaced medial epicondyle of the humerus.All of the cases were followed-up for a mean of 8.6 months.All fractures healed in a mean of 4.2 weeks.According to Tibone and Stoltz function scale,12 were excellent,4 were good and one fair.No other complication took place except for a nail end irritation resulting in a bursa.Conclusions Both PKWL and CIMP can independently reduce the fractures.In case of severely tilted and displaced fractures,both of these two methods will be required.PKWL seems to be able to achieve better reduction. Key words: Radial neck fracture; Close reduction; Child