Neck Fractures In Children Research Articles

Comparative Analysis of the Results of Treatment for Metacarpal Neck Fractures in Children with Antegrade and Retrograde Kirschner Wire Fixation

Introduction. Among hand injuries, the proportion of metacarpal fractures is 9.6–40.0 %. Currently, there is no single approach to the treatment of children with such injuries.The aim is to determine the optimal method of surgical treatment of metacarpal fractures in children by comparative analysis of the results of antegrade and retrograde osteosynthesis with Kirchner spokes.Materials and methods. A prospective cohort study included 186 children with closed head fractures of the II–V metacarpal bones. The main group consisted of 103 children (55.38 %) who underwent antegrade osteosynthesis; the control group consisted of 83 children (44.62 %) who had needles retrograde. Local inflammatory changes were assessed on the 3rd and 7th days after surgery. The volume of active movements in the metacarpophalangeal joints was measured after 3, 6 and 12 weeks.Results. At week 3 of follow-up, the median amplitude of movements in the metacarpophalangeal joints in patients of the main group was 18 [13; 26] degrees, in the control group — 7 [4; 9] (p < 0.001); at week 6–59 [49; 72] and 35 [32; 54] (p < 0.001) At week 12–89 [84; 90] and 82 [74; 86], respectively (p < 0.001). Macroscopic assessment of the needle insertion area on the 3rd day after surgery showed the absence of local inflammatory changes in 92 (89.3 %) and 73 patients (88.0 %) of the main and control groups (p = 0.953); on day 7, in 100 (97.1 %) and 76 (92.5 %), respectively (p = 0.497), however, the differences were not statistically significant.Discussion. The optimal way to treat metacarpal fractures in children should be technically simple and low-traumatic. The importance of early rehabilitation for restoring the volume of movement in the joints of the hand is confirmed by many studies.Conclusion. Due to the minimization of damage to the articular surfaces and the early start of rehabilitation, the best functional results were achieved in the antegrade osteosynthesis group.

Metaizeau technique in stabilizing Monteggia equivalent 1b associated proximal radial physeal injury in a rural setting: a case report

Introduction: The Monteggia equivalent type 1b fracture, consisting of an ulnar shaft fracture and radial head dislocation, is a rare condition first described by Giovanni Battista Monteggia. The Metaizeau technique, emphasizing percutaneous intramedullary fixation to preserve bone healing and prevent growth plate damage, has gained prominence in managing these fractures. Case report: A 10-year-old boy presented with left forearm pain, swelling, and deformity following a fall while playing football. X-rays revealed a proximal fourth ulnar fracture with dorsal and lateral angulation, along with a proximal radial metaphyseal fracture showing anterior rotation and physeal extension. This fracture pattern resembled a Monteggia fracture type III but differed in the lateral proximal radial disruption via a Salter–Harris type II fracture rather than radial epiphysis dislocation. Satisfactory reduction achieved for ulna was managed with standard nailing system but could not be achieved for radial physeal injury, which was managed with Metaizeau technique. Discussion: Type 1b Monteggia equivalents involving a Salter–Harris type 2 fracture of the proximal radius with an associated proximal ulnar fracture, adherence to Monteggia fracture reduction principles is vital. Closed reduction and internal fixation are preferred treatments, with the Metaizeau technique offering advantages such as minimal invasiveness and avoidance of implant-related complications. The Metaizeau technique is particularly beneficial for displaced radial neck fractures in children, providing stable fixation while preserving the fracture environment necessary for optimal healing. Conclusion: In cases of Monteggia fracture equivalents, most proximal radial fractures typically reduce to an acceptable level following ulnar reduction. However, proximal radial physeal fractures may require specific attention to achieve satisfactory reduction. The Metaizeau technique, commonly employed in the management of isolated radial neck fractures, can be utilized to achieve this reduction to an acceptable level.

Clinical effects of percutaneous elastic intramedullary nail assisted by arthrography for the treatment of radial neck fractures in children

To explore clinical effect of closed reduction percutaneous elastic intramedullary nail assisted by arthrography in the treatment of radial neck fracture in children. A retrospective analysis was performed on 23 children with radial neck fracture treated with arthrography assisted closed reduction and percutaneous elastic intramedullary nail internal fixation (arthrography with elastic nail group) from January 2019 to December 2022, including 12 males and 11 females, aged from 2 to 12 years old with an average of (7.36±1.89) years old;According to Judet fracture types, 14 children were type Ⅲ and 9 children were type Ⅳ. In addition, 23 children with radial neck fracture were selected from January 2015 to December 2018 who were treated with closed reduction and percutaneous elastic intramedullary nail fixation (elastic nail group), including 11 males and 12 females, aged from 2 to 14 years old with an average of (7.50±1.91) years old;Judet classification included 15 children were type Ⅲ and 8 children were type Ⅳ. Operative time and intraoperative fluoroscopy times were compared between two groups. Metaizeau evaluation criteria was used to evaluate fracture reduction, and Tibone-Stoltz evaluation criteria was used to evaluate functional recovery of elbow between two groups. Both groups were followed up for 12 to 24 months with an average of (16.56±6.34) months. Operative time and intraoperative fluoroscopy times of elastic nail group were (56.64±19.27) min and (21.13±7.87) times, while those of joint angiography with elastic nail group were (40.33±11.50) min and (12.10±3.52) times;there were difference between two groups (P<0.05). According to Metaizeau evaluation, 11 patients got excellent result, 9 good and 3 fair in joint angiography with elastic nail group, while in elastic nail group, 5 excellent, 13 good, 4 acceptable, and 1 poor;the difference between two groups was statistically significant (P<0.05). According to Tibone-Stoltz criteria, 14 patients got excellent result, 8 good, and 1 fair in joint arthrography with elastic nail group;while in elastic nail group, 12 patients got excellent result, 9 good, 1 fair and 1 poor;there was no significant difference between two groups (P>0.05). Compared to percutaneous elastic intramedullary nail fixation, closed reduction assisted by arthrography has advantages of reduced operation time, decreased intraoperative fluoroscopy frequency, and improved fracture reduction. Arthrography enables clear visualization of the anatomical structures of radius, head, neck, bone, and cartilage in children, facilitating comprehensive display of fracture reduction and brachioradial joint alignment. This technique more precisely guides the depth of elastic intramedullary nail implantation in radius neck, thereby enhancing surgical efficiency and success rate.

Radial neck fracture in children-"Abenign fracture?"

Radial neck fractures in children are rare but clinically relevant injuries that are often accompanied by concomitant injuries. Girls between the ages of8 and 12 years old are more frequently affected, whereby acubitus valgus variant can be apredisposing factor. The main trauma mechanism is afall onto the outstretched, supinated arm with additional valgus stress. Radial neck fractures can be associated with concomitant injuries of the elbow joint, including an olecranon fracture and elbow dislocation. The diagnosis is typically made by conventional X‑radiographs, although ultrasonography can be indicated in younger children.The treatment depends on the fracture dislocation. Conservative treatment is certainly possible at any age if the proximal fragment is angulated less than 20°, while asurgical intervention can be indicated for larger dislocations depending on age. Closed reduction with internal fixation using aelastic stable intramedullary nail (ESIN) according to Métaizeau has become established as the standard procedure. Complications such as premature epiphyseal joint closure, synostosis, avascular necrosis, pseudarthrosis and deformation of the radial head can occur and affect the functional outcome. The treatment of such complications often requires acomprehensive multidisciplinary approach and can include both conservative and surgical measures. Long-term studies show that most patients with radial neck fractures achieve good to very good outcomes, although certain predictive factors are associated with poorer outcomes.Knowledge of the potential complications and their treatment is crucial for the successful management of children with radial neck fractures and should be considered when making clinical decisions.

Long-term outcome of robotic-guided closed reduction internal fixation for Delbet II femoral neck fractures in children

ObjectiveTo retrospectively analyze and assess the long-term effectiveness of robotic navigation and traditional closed reduction internal fixation in the treatment of Delbet type II femoral neck fracture in children.MethodsA total of fifty-five patients diagnosed with pediatric Delbet type II femoral neck fracture, who were admitted to Foshan Hospital of Traditional Chinese Medicine between January 2018 and June 2022, were included in this study. Among them, 22 cases of nailing under robotic navigation were set as the observation group, and 33 cases of nailing under fluoroscopy of the C-arm machine were set as the control group. All patients had their femoral neck fractures closed and repositioned first. After confirming the satisfactory fracture repositioning under the fluoroscopic view of the C-arm machine, internal fixation was performed by inserting hollow compression screws in the corresponding surgical way.A comparative analysis was conducted between the two groups to assess the disparity in the amount of X-ray exposure during surgery, the number of guide pins inserted, and the duration of the surgical procedure. The quality of comparative fracture reduction was assessed according to the Haidukewych criteria on the first postoperative hip X-ray, and the parallelism and distribution of the comparative screws were measured. The incidence of hip function and postoperative complications according to the Ratliff criteria were evaluated between each of the subgroups at the final follow-up.ResultsComparison of general information, operation duration, and quality of fracture reduction between the two groups failed to reveal statistically significant results (P > 0.05). The observation group had a lower number of X-ray exposures and guide pin placements compared to the control group, and this difference was statistically significant (P < 0.05).At the last follow-up, the observation group exhibited superior screw parallelism and distribution, as well as hip joint function, compared to the control group, and this difference was statistically significant (P < 0.05). The incidence of complications in the observation group was lower than that in the control group; however, the difference was not statistically significant (P > 0.05).ConclusionClosed reduction and internal fixation under orthopedic robot navigation can achieve better long-term efficacy in treating Delbet type II femoral neck fracture in children.

A new method for evaluating radial neck fractures based on Judet classification.

To propose a new method for evaluating paediatric radial neck fractures and improve the accuracy of fracture angulation measurement, particularly in younger children, and thereby facilitate planning treatment in this population. Clinical data of 117 children with radial neck fractures in our hospital from August 2014 to March 2023 were collected. A total of 50 children (26 males, 24 females, mean age 7.6 years (2 to 13)) met the inclusion criteria and were analyzed. Cases were excluded for the following reasons: Judet grade I and Judet grade IVb (> 85° angulation) classification; poor radiograph image quality; incomplete clinical information; sagittal plane angulation; severe displacement of the ulna fracture; and Monteggia fractures. For each patient, standard elbow anteroposterior (AP) view radiographs and corresponding CT images were acquired. On radiographs, Angle P (complementary to the angle between the long axis of the radial head and the line perpendicular to the physis), Angle S (complementary to the angle between the long axis of the radial head and the midline through the proximal radial shaft), and Angle U (between the long axis of the radial head and the straight line from the distal tip of the capitellum to the coronoid process) were identified as candidates approximating the true coronal plane angulation of radial neck fractures. On the coronal plane of the CT scan, the angulation of radial neck fractures (CTa) was measured and served as the reference standard for measurement. Inter- and intraobserver reliabilities were assessed by Kappa statistics and intraclass correlation coefficient (ICC). Angle U showed the strongest correlation with CTa (p < 0.001). In the analysis of inter- and intraobserver reliability, Kappa values were significantly higher for Angles S and U compared with Angle P. ICC values were excellent among the three groups. Angle U on AP view was the best substitute for CTa when evaluating radial neck fractures in children. Further studies are required to validate this method.

Metaizeau Technique for Treatment of Paediatric Isolated Radial Neck Fracture - Clinical and Radiological Outcomes - Case Control Study.

Radial neck fractures account for 5-17% of elbow fractures and about 1% of all fractures in children. The subject of the presented research is assesment of clinical and radiological outcomes of the Metaizeau technique for treatment of isolated radial neck fractures in children. Retrospective analysis of clinical and radiological data of patients treated with the Metaizeau technique in our Department between 2015 and 2020. Twenty children with isolated radial neck fracture met the inclusion criteria. Excellent outcomes of operative treatment were achieved in 95% of children. None of the complications described in the literature (e.g. avascular necrosis of radial head (AVN), malunion, nonunion) were observed in our case series. 1. The Metaizeau technique for reduction and stabilisation of the radial neck fracture using a TEN is a safe and effective method in the paediatric population and produces good clinical and radiological results. 2.Furthermore, the minimal demands it places on surgical equipment make it possible for this technique to be recommended to orthopaedic surgeons managing paediatric trauma patients.

Comparison of midterm efficacy of Kirschner wires and elastic intramedullary nails after closed reduction of Judet type 3 radial neck fractures in children: a multicenter study.

The objective of this study was to compare the midterm efficacy of Kirschner wires and elastic intramedullary nails after the closed reduction treatment of Judet 3 radial neck fractures in children. This was a retrospective multicenter study of patients diagnosed with Judet type 3 radial neck fractures who underwent closed reduction and internal fixation at four tertiary hospitals from January 2019 to December 2021. Gender, age, fracture type, operation time, follow-up time, x-ray results and complications were collected. The recovery of elbow joint between the two internal fixation methods, elbow motion and complications at the last follow-up were compared. The average operation time of EIN group was statistical significantly increased compared with KW group. There were no significant differences in MEPS score and ROM 3 months after surgery between the two groups, but the ROR Angle of EIN group was statistical significantly increased compared with KW group 3 months after surgery. There were no significant differences in MEPS score, ROM and ROR at the last follow-up. The incidence of complications in EIN group was significantly lower than that in KW group. The use of elastic intramedullary nails fixation or Kirschner wires fixation in the treatment of radial neck fractures in children can both achieve satisfactory fracture reduction and healing. Compared with elastic intramedullary nails, the operation time of Kirschner wires fixation is shorter, and the internal fixation does not need to be removed under anesthesia again, but the complication rate is higher.

Characteristics of femoral neck fractures in osteogenesis imperfecta: Series of four-teen consecutive hips in twelve patients

IntroductionWhile long bone fractures are commonly seen in individuals with Osteogenesis Imperfecta (OI), femoral neck fractures (FNF) are exceedingly rare. There is a lack of comprehensive data regarding the etiology of FNFs, their characteristics, and the treatment protocols. Our aim was to determine the characteristics of femoral neck fractures in children with OI. Materials and methodsThis study was conducted as retrospective series covering period of January 2011-December 2022. Total of 14 femoral neck fractures in 12 patients were included into final analysis. Age, gender, fracture location, ambulation level, injury mechanism, Sillence type, pre-fracture collo-diaphyseal angle, presence of previous implants and applied treatments were noted. ResultsThe mean age was 9.3 (range: 3–16), 8 out of 12 patients were males. Sillence type 3 OI was most common (50 %) type. Among 12 patients, 2 (16.6 %) were restricted ambulatory while 5 (41.6 %) were non-ambulatory. Seven patients had prior femoral implants. Six fractures were managed non-operatively, while others underwent surgery, with cannulated screws (42.8 %) or plate osteosynthesis (7.1 %). All eight cases (100 %) with minor trauma or unknown origin were Sillence type 3–4, displaying varus deformity. FNFs that occured in mobile patients required higher-energy traumas. ConclusionFemoral neck fractures in OI showed differing trauma mechanisms in ambulatory vs. non-ambulatory patients. Non-surgical treatment may be considered with in patients with high-risk anesthesia concerns, requiring higher level clinical studies.

Modified Kirschner wire percutaneous rotation prying reduction combined with elastic stable intramedullary nailing in children with Judet IV radial neck fracture

PurposeThis study was to investigate the feasibility and treatment effect of using modified Kirschner wire (K-wire) percutaneous rotation prying reduction combined with Elastic Stable Intramedullary Nailing (ESIN) in children with Judet IV radial neck fracture.MethodsA retrospective analysis was conducted on 47 children with Judet IV radial neck fracture who underwent treatment with modified K-wire percutaneous rotation prying reduction combined with ESIN from April 2019 to November 2022, including 25 males and 22 females, with an average age of 8.79 years old (ranging from 5 to 14). The study recorded the surgical time, fluoroscopy time, reduction time, and reduction quality evaluated according to the Metaizeau radiological standard. During the last follow-up, the flexion-extension and forearm rotation function of the affected and healthy sides were recorded, and the Mayo Elbow Performance index was used to evaluate the elbow joint function.ResultsThe average duration of the operation was 25.51 min (ranging from 14 to 43 min), with a mode of 2 reset times (ranging from 1 to 5) and 8 fluoroscopic times (ranging from 4 to 15). Based on the Metaizeau radiological standard for assessing reduction quality, 45 cases were deemed excellent, while 2 cases were considered good. Following 3–4 weeks of postoperative long-arm cast immobilization, exercises were performed to promote elbow joint and forearm rotation. The ESIN was removed after satisfactory fracture healing around 4 months postoperatively. The average follow-up period was 26.79 months (ranging from 5 to 48). At the final follow-up, the range of motion for the affected limb in flexion, extension, pronation, and supination was (140.23 ± 4.80)°, (4.43 ± 3.98)°, (84.09 ± 4.97)°, and (83.83 ± 4.55)°, respectively. There was no statistically significant difference compared to the healthy side, which had a range of motion of (141.36 ± 3.27)°, (5.28 ± 2.25)°, (85.66 ± 3.20)°, and (84.98 ± 2.57)° (P > 0.05). According to the Mayo Elbow Performance index, 44 cases were rated as excellent and 1 case was considered good.ConclusionThe modified K-wire percutaneous rotation prying reduction combined with ESIN is an effective treatment for severe radial neck fractures in children. This technique offers several advantages, including the ability to easily “capture” significantly displaced radial heads, achieve rapid and accurate reduction, and reduce radiation exposure.

Predictive factors for open reduction of operatively treated radial neck fractures in children

IntroductionOpen reduction is a therapeutic option for displaced radial neck fracture in children, which once was considered the last resort because of its potential risk for functional outcomes. This study aimed to identify risk factors for open reduction in operatively treated radial neck fractures in children. Patients and methodsOne hundred and thirty-seven patients with displaced radial neck fractures, treated surgically at our department from January 2010 to December 2021 were retrospectively enrolled. Patients’ data of age, sex, injury side, obesity, type of fractures, combined fractures, nerve injury, reduction methods, and delay from injury to surgery were reviewed. Univariate analysis and multivariate logistic regression were used to identify independent risk factors and odds ratios of open reduction. ResultsOverall, 137 patients (62 females and 75 males) with an average of 8.0 ± 2.2 years were analyzed. There were 62 cases of type III fractures and 75 cases of type IV based on the Judet classification. Thirty-two cases had combined fractures and 19 cases presented with nerve injury. The open reduction rate was 24.1 % (33/137). Univariate analysis indicated obesity, fracture type, and combined fractures were significantly associated with open reduction. (P = 0.039, P = 0.000 and P = 0.000, respectively). While multivariate logistic regression analysis showed that only fracture type (OR, 5.18; CI, 1.63–16.46, p = 0.005) and combined fractures (OR, 7.79; CI, 2.97–20.41, p = 0.000) were independent risk factors for open reduction. ConclusionsJudet type IV fracture and combined fractures are two significant risk factors for open reduction in operatively treated radial neck fractures in children. These findings will facilitate preoperative decision making, remind surgeons of the risk of failure in closed reduction and the use of new surgical techniques to decrease the open reduction poor outcome rate.

A comparative study: Ultrasound-guided leverage reduction with internal fixation using Kirschner wires or elastic stable intramedullary nailing for severely displaced radial neck fractures in children.

Treatment of radial neck fractures (RNFs) in children, particularly those with severe displacement or angulation, remains controversial, largely due to the challenge of achieving optimal reduction without resorting to open reduction. This study aimed to assess the outcomes of ultrasonography (US)-guided percutaneous leverage reduction coupled with US-guided fixation using either elastic stable intramedullary nail (ESIN) or Kirschner wire (KW) for severely displaced Judet type III and IV RNFs in children. We hypothesized that both strategies would be effective and aimed to identify the superior approach. A total of 38 pediatric patients presenting with Judet type III and IV RNFs resulting from falls were treated surgically between January 2020 and January 2022. The cohort comprised 15 boys and 23 girls, aged on average 7.6 ± 2.3 (range: 2.8-11.3 years). The fractures were classified as type III (n = 28) and type IV (n = 10). The patients were divided into 2 treatment groups: ESIN group (n = 15; treated with US-guided percutaneous leverage reduction and ESIN fixation) and the KW group (n = 23; treated with US-guided percutaneous leverage reduction and KW fixation). Variables such as surgical time, frequency of intraoperative radiography, fracture healing time, hospitalization costs, radiographic outcomes, and functional elbow scores were analyzed. Most fractures demonstrated both clinical and radiographic evidence of complete healing within 7 weeks. Based on the Tibone and Stoltz classification (Tibone J, Stoltz M. Fractures of the radial head and neck in children. J Bone Joint Surg Am. 1981;63:100-6), almost all patients had excellent or good clinical outcomes, with only one exception in the ESIN group. The KW group exhibited significantly lower hospitalization costs compared to the ESIN group [(9562.6 vs 12,043.6 + 7694.0)¥, P < .05]. Both groups required notably few intraoperative radiographic exposures (KW: 5.4 ± 2.1 times, ESIN: 4.0 ± 1.9 times, P < .05). No major complications were reported. However, one case of ESIN displacement and joint protrusion was noted. Our study suggests that US-guided percutaneous leverage reduction, combined with either ESIN or KW fixation, is an effective treatment for severely displaced radial neck fractures in children. Both treatment modalities resulted in notably few intraoperative radiographic exposures and yielded favorable clinical and radiological outcomes. The integration of US-guided leverage reduction and KW fixation is both cost-effective and safe.

A Case of an Atypical Radial Neck Fracture in Children

A Case of an Atypical Radial Neck Fracture in Children

Elastic-stable intramedullary nailing for radial neck fractures in children: clinical and radiological outcomes and risks for poor prognosis

Introduction. Radial neck fractures in children are rare and account for 1-3% of all childhood trauma. Severe displacement of the fracture can lead to a higher incidence of complications, such as limited range of motion (ROM ), pain, instability, neurovascular trauma, premature physeal closure, cubitus valgus, radial head overgrowth, avascular necrosis and improper ossification. The treatment outcome depends on the injury type, treatment method and presence of complications. Aim. The purpose of the study was to assess the outcome of patients treated with elastic-stable intramedullary nailing (ESIN) regarding different radial head angulations and to search for risk factors of a poor outcome. Materials and methods. Twenty-six consecutive patients treated between October 2020, and March 2022, due to radial neck fracture were included in the study. Closed reduction and ESIN fixation were performed. If failed, A K-wire assisted reduction or open reduction was performed. A radiological evaluation was performed pre- and post surgery and at the last follow-up. At the last follow-up visit, the elbow range of motion (ROM ) was measured and the Mayo Elbow Performance Score (MEPS) was established. The followup was after 25 months. Results. The angulation before surgery was 42.4° and the next day after surgery was 6.9°, p = 0.0001. Further correction was observed and at the last follow-up it was 2.5°, p = 0.001. We found no complications besides one skin irritation by an implant and 2 reduced ROM . The MEPS was 97.7. The difference in MEPS between Judet IVB (angulation before surgery&gt; 80°) 92.5 and other patients 98.6 was significant, p = 0.04674. There was no significant difference in MEPS, ROM , between patients immobilized in a plater cast versus in a sling, Conclusions. Closed reduction with the use of ESIN can be considered a safe procedure with a low rate of complications. Patients with an angulation &gt;80° revealed worse functional effects. Cast immobilization did not reveal a negative or a positive impact on the treatment result.

Clinical and radiological evaluation of radial neck factures in children and adolescents treated by percutaneous leverage reduction with Kirschner wire stabilization

PurposeThe aim of the study was to evaluate the clinical and radiological results of surgical treatment of radial neck fractures in children and adolescents by percutaneous leverage with Kirschner wire stabilization.MethodsA retrospective clinical and radiographical evaluation was performed on a cohort of 61 patients (mean age 9.7 years; range 3 to 15) with isolated, unilateral radial neck fractures treated between 2009 and 2019. The mean duration of follow-up was 4.2 years (range 2 to 9 years). All fractures were types III and IV according to Judet’s classification.ResultsAfter mean follow-up, the radiographic results according to Metaizeau were rated as excellent in 70.5% of respondents, good in 27.9%, satisfactory in 1.6%. According to Mayo Elbow Performance Score, 95.1% of respondents obtained a very good result, 3.3% good, and 1.6% satisfactory. The mean radial neck–shaft angle changed from a mean 51.5° before operation to 3.8° postoperatively (p<0.001). The mean translation was 3.1mm before surgery and 0.5mm postoperatively (p<0.001). No limb axis deviation, elbow joint instability, and infection of the implant insertion site were observed. No statistically significant differences were noted between girls and boys (p>0.05).ConclusionsOur findings indicate that percutaneous leverage with Kirschner wire stabilization is an effective and safe method for treating isolated radial neck fractures, characterized by a low risk of iatrogenic complications.

Risk factors related with avascular necrosis after internal fixation of femoral neck fractures in children: a systematic review and meta-analysis.

Less than 1% of children develop femoral neck fractures (FNF), making them uncommon. However, they may have dangerous side effects, like avascular necrosis. Even though several risk factors for postoperative avascular necrosis have been identified, there is still debate regarding them. In this investigation, a meta-analysis was performed to examine the potential causes of postoperative avascular necrosis in children with FNF. We conducted a thorough literature search to find risk factors for avascular necrosis (AVN) after internal fixation of pediatric FNF. Until December 2022, we searched several databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, Orthosearch, and Sinomed. Software Zotero 6.0 and Stata 17.0 were used to organise and synthesise the data. Finally, a sensitivity and publication bias test was carried out. Our study includes a total of 15 case-control studies involving 814 patients. The risk of postoperative AVN increased with age at fracture encounter (95% CI: 0.64-1.88, P = 0.0003), initial fracture displacement (95% CI: 1.87-9.54, P = 0.0005), and poor fracture reduction (95% CI:1.95-22.34, P = 0.0024) were risk factors for postoperative AVN. There was no significant relationship between gender and postoperative AVN (95% CI: 0.52-1.31, P = 0.41). Conversely, Postoperative AVN and reduction methods have no connection with each other (95% CI: 0.77-2.66, P = 0.25), procedure time (95% CI: 0.43-2.99, P = 0.16), or injury mechanism (95% CI: 0.32-2.26, P = 0.75). The incidence of post-operative AVN varies between Delbet fracture types (95% CI: 0.15-0.31, P < 0.0001), with the overall trend being that the incidence of post-operative AVN is highest for type II, lowest for type IV, and close for types I and III, but it is not clear which type of fracture is the independent risk factor. Funnel plots indicate no significant publication bias. In line with this study, About 26% of children who underwent surgery for a femoral neck fracture suffered postoperative AVN. The main risk factors for AVN were the child's age, the initial displacement of the fractures, and poorly reduced fractures. The risk of AVN did not significantly correlate with gender, the time of the procedure, reduction methods or the mechanism of injury. The overall trend in the incidence of postoperative AVN for the different Delbet types of fracture is that the incidence of postoperative AVN is highest for type II, lowest for type IV, and close for types I and III, but it is not clear which type of fracture is the independent risk factor.

Comparison of splinting immobilization and K-wire fixation in children with type II phalange neck fracture.

To compare outcomes of type II phalangeal neck fractures in children who received closed reduction followed by splinting immobilization or by K-wire fixation. Furthermore, we analyzed the remodeling potential of residual deformities and the relationship between age and outcomes. Patients in Children's Hospital of Fudan University, Xiamen Hospital were included in the study from October 2015 to October 2018. We compared outcomes between the conservation group and operation group. Remodeling of residual deformities was calculated on a series of anteroposterior and lateral radiography. The correlation between age and outcomes was analyzed using Spearman's rank correlation coefficient. Forty patients (25 males) were enrolled. Nineteen patients had subtype IIa, 19 subtype IIb, and two subtype IIc fractures. Left hands were affected more than right hands, and small finger and proximal phalanx were more frequently involved. There were no significant differences between conservation group and operation group among excellent, good, and fair outcomes. And the outcomes were not significantly different between the IIa and IIb subtypes. An average sagittal remodeling rate was 88.5%, and coronal remodeling rate was 56.71%, respectively, in 13 patients with residual deformities. There was a significant correlation between age and final outcomes. Closed reduction and stable splint fixation may be an effective and economical initial treatment option. Fracture subtype does not seem to be a key factor for choosing treatment options. The fractured phalangeal neck had remodeling potential whether on sagittal or coronal plane. Younger age might be a predictor of better outcomes in children with type II phalanx neck fractures.

Functional outcomes of fixation of radial neck fractures in children by Metaizeau technique: A case series

Radial neck fractures account for 1% of all fractures in children and 5% to 14% of traumatic elbow injuries. They are mainly caused by having fallen onto an out-stretched hand. Classification: O’Brien and Judet classification.The purpose of this study was to review the functional outcomes of the management of radial neck fractures in pediatric age group using Métaizeau technique.A prospective observational analysis was performed on 8 patients who underwent closed reduction and internal fixation with elastic intramedullary nailing using Métaizeau technique for fracture neck of the radius. Pediatric patients in the age group of 3-12 years with Judet type 3 and Judet type 4 radial neck fractures were taken for our study. The patients were followed up for a period of 3 months and thorough radiological and clinical examination was carried out with due attention to any complication. The final results were scored on the basis of Mayo Elbow Score.As per the above criteria we recorded 3 excellent, 2 fair outcomes for type 3 fractures, whereas for type 4 fractures 1 excellent, 1 fair and 1 good outcomes. Neurovascular deficit or deep infection was not reported. We did not notice any penetration of the nail into the joint.With Metaizeau technique, there were reported poor results of about 10% in literature. Our results support the Métaizeau technique and postulate that the usage of a nail with reshaped tip may help in avoiding revision surgery by minimizing the loss of reduction.

Fibular Strut Graft with Cannulated Hip Screw of Neglected Femoral Neck Fracture in a Young Adult: A Case Report

BACKGROUND: Neglected femoral neck fractures in young adults (age &lt;60) pose a major challenge in terms of appropriate treatments for each specific condition. AIM: The objective of this case report is to explain the presentation of neglected femoral neck fractures and its clinical consequences and to discuss the management of the disease. CASE PRESENTATION: This case presents a 14-year-old male with neglected displaced fracture of femoral neck, which was successfully managed by closed reduction and internal fixation with two cannulated screws and non- vascularized fibular strut graft. CONCLUSION: Femoral neck fractures in young adults are considered as a rare fracture case, eventually it was associated with serious complications. The management of this type of fractures in children is challenging, particularly that of a neglected fracture. Fibular strut graft with two cannulated hip screws for neglected femoral neck fractures in children considered to be cost-effective and technically less demanding as well as associated with good outcomes.

PROSPECTIVE STUDY TO EVALUATE FUNCTIONAL OUTCOME OF PAEDIATRIC RADIAL NECK FRACTURES TREATED BY METAIZEAU TECHNIQUE

Background: Radial neck fractures in children are a rare injury, and the timing of surgery as well as the surgical technique will determine how well they respond to treatment. When the tilt surpasses 60 degrees, radial neck fractures in children are signicant injuries with frequent after effects. In these situations, conservative treatment is frequently insufcient, and open reduction may result in iatrogenic consequences. Retrograde intramedullary nailing of the radius is one method of treating dislocated radial neck fractures in children (the Metaizeau technique). Aim: The purpose of this study was to evaluate the functional outcome of Metaizeau technique. Methodology: After taking proper consent and ethical clearance a prospective study was conducted in 16 cases of closed radial neck fractures in children aged 6-12 years without any neurovascular decit. Patients were treated by Metaizeau technique at Jorhat medical college and Hospital from 2021-2022 and were followed up at 2 weeks, 4 weeks, 6 weeks, 10weeks and 12 weeks. Result: In this study, it is found that this technique is safe and effective in treating radial neck fracture in children. The fracture should be reduced within 7 days of injury. Later on, fracture reduction will be difcult because of brosis and fracture healing. In our study, average age was 9 years. Males were affected more than females and the common mode of injury was fall on outstretched hand. All cases achieved radiological and clinical union by 6 weeks. All cases achieved comparable exion-extension of elbow, supination-pronation of the forearm (as compared to healthy side). Average MEPS was 82.19 which was quite remarkable. Only one patient developed entry site pressure necrosis by cut end of TENS nail. The other disadvantage of this technique was need of second surgery for tens removal. Metaizeau technique is a minimally Conclusion: invasive technique with easy learning curve, minimal tissue damage, and reduced chance of elbow stiffness and osteonecrosis of radial head. Our results are within the acceptable range of satisfactory outcomes, if not more towards the better end of the outcomes quoted in literature.