Posterior Interosseous Nerve Palsy Research Articles

Outcome analysis of hybrid fixation technique (radius nailing and ulna plating) in closed proximal radius and ulna fractures in adults

Background: The aim of the study was to evaluate results of hybrid fixation technique (radius nailing and ulna plating) in closed proximal radius and ulna fractures in adults. The hypothesis behind hybrid fixation is to provide rigid fixation and restoration of forearm length, by ulna plating and large diameter square nail in radius gives rotational stability without any posterior interosseous nerve palsy in proximal radius and ulna fractures. Closed nailing of proximal radius avoid posterior interosseous nerve palsy which has high probability in open surgical approach.Materials and method: We prospectively evaluated 25 patients with closed proximal radius and ulna fractures. 20 males and 5 females with mean age of 30.7 years underwent closed reduction and intramedullary nail fixation in radius and open reduction internal fixation in ulna with plating. The fractures were classified according to the AO/OTA system. The average follow up was 1 year (range 6 months – 18 months). Results: The average time to union was 12.77 weeks (10-14 weeks). Union was achieved in all 25 patients in both radius and ulna. Using the Grace and Eversmann rating system7 patients were excellent, 16 good, 1 acceptable and 1 unacceptable results. Using Andersons scale 23 patients had an excellent, 2 unsatisfactory, 0 failure. None of the patients had intraoperative as well as postoperative complications and no posterior interosseous nerve palsy occurred in any of case. Conclusion: Closed reduction internal fixation with use of Hybrid fixation modality in closed proximal radius and ulna fractures has good results. Rigid fixation by ulna plating and rotational stability in radius by large diameter square nail provides almost the same construct as with dual plating with minimal invasive approach. Complication rates are lower as compared to plate osteosynthesis especially with similar union rates in terms of posterior interosseous nerve palsy.

Functional Outcomes of Compression Plating and Bone Grafting for Operative Treatment of Nonunions About the Forearm.

To describe one center's experience with nonunion of one or both bones of the forearm and report on the functional recovery of patients treated for a single- or 2-bone forearm nonunion. We performed a retrospective analysis of 23 patients who presented to our institution over an 11-year period and underwent surgical repair of a forearm nonunion (radius, ulna, or both bones). The main outcome measurements included time to union, visual analog scale pain scores, range of motion, Short Musculoskeletal Function Assessment scores, and postoperative complications. Of the 23 patients, 21 (91.3%) healed their nonunion after a single surgical procedure. All patients ultimately healed their nonunion; 7 patients were healed at 3-month follow-up, 11 healed at 6-month follow-up, and 5 healed at 12-month follow-up. Mean visual analog scale pain scores improved considerably from presentation to latest follow-up. The mean range of motion at the latest follow-up was as follows: elbow 130.9° flexion-extension arc, forearm 78.5° pronation/77.8° supination, and wrist 76.1° palmar flexion/74.3° dorsiflexion. Mean Short Musculoskeletal Function Assessment arm and hand index scores improved significantly from baseline to the latest follow-up. Mean Short Musculoskeletal Function Assessment function, activity, and bothersome indices demonstrated improvement, though this was not statistically significant. Two patients required further surgery to achieve osseous union. One patient sustained an iatrogenic posterior interosseous nerve palsy, which resolved spontaneously. Repair of forearm nonunion with compression plating and bone grafting provides reliable clinical and functional outcomes. Patients treated surgically for nonunion of one or both of the forearm bones can expect to heal with the potential for considerable improvements in pain and function postoperatively. Therapeutic IV.

Retrospective Analysis of 20 Patients With Schwannomas: Magnetic Resonance Imaging Characteristics, Pain, and Outcomes Following Excision.

A Tinel's sign, a percussion-induced, painful sensation, has been reported as the most useful sign for diagnosing a schwannoma. On magnetic resonance imaging, schwannomas often exhibit a split fat sign and a target sign. The typical treatment for schwannomas is surgical excision; however, excision often results in high rates of neurological deficit. The authors retrospectively reviewed 20 patients who underwent excision of a schwannoma from 2007 to 2015. Twenty patients presented with a split fat sign and 12 patients presented with a Tinel's sign on magnetic resonance imaging. Only 3 patients presented with a target sign on magnetic resonance imaging. The operative approach involved removing the schwannoma, preserving the nearby nerve fascicles, and leaving the epineurium open. Follow-up ranged from 3 to 91 months (average, 29 months). At final follow-up, all patients were pain free. Nineteen patients had normal sensation and full function of their affected limb. One patient developed postoperative posterior interosseous nerve palsy. A Tinel's sign, preoperative pain, and a split fat sign on preoperative magnetic resonance imaging are the clinical symptoms most useful for diagnosing a schwannoma. Schwannomas can be safely removed via intracapsular surgical excision with minimal complications, yielding eradication of preoperative pain, normal sensation, and full function. [Orthopedics. 2017; 40(6):e1036-e1043.].

Analysis of 784 Surgically Treated Distal Biceps Tendon Ruptures

The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, two-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and re-operation rate. To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multi-specialty, integrated healthcare system. Retrospective cohort study of distal biceps tendon repairs performed from January 1, 2008 through December 31, 2015. The repair methods were classified as: two-incision approach using bone tunnel-suture fixation, or anterior single incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, surgical outcomes, and complications were analyzed for all repair types. Of the 784 repairs that met our inclusion criteria, 639 (81.5%) were single incision approaches. When comparing two-incision and single incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs. 0.8% respectively, P: 0.010), heterotopic bone formation (7.6% vs 2.7%, respectively. P: 0.004), and re-operations (8.3% vs 2.3%, respectively. P<0.001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single incision and two-incision (5.8% vs. 6.9%, respectively, P: 0.612). The overall rate of tendon re-rupture was 1.9% (single incision: 1.6%, two-incision: 2.8%, P: 0.327). The overall rate of post-operative wound infection was 1.5% (single incision: 1.3%, two-incision: 2.8%, P: 0.182). The average time from surgery to release from medical care was 14.4 weeks (single incision: 14.0 weeks, two-incisions: 16.0 weeks, P: 0.286). Patients treated with cortical button + interference screw were released significantly sooner than other single incision repair types (13.1±8.01 weeks, P: 0.011). There were no significant differences in rates of motor neuropraxia, infection, re-rupture, re-operation in regards to surgeon’s years of practice, fellowship training, or case volume. The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, two-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and re-operation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications.

Surgical Treatment of Distal Biceps Tendon Ruptures: An Analysis of Complications in 784 Surgical Repairs

Background: Distal biceps brachii tendon ruptures lead to substantial deficits in elbow flexion and supination; surgical repair restores muscle strength and endurance. Purpose: To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multispecialty, integrated health care system. Study Design: Cohort study; Level of evidence, 3. Methods: Retrospective cohort study of distal biceps tendon repairs performed between January 1, 2008, and December 31, 2015. The repair methods were classified as double-incision approach using bone tunnel–suture fixation or anterior single-incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, range of motion, and complications were analyzed for all repair types. Results: Of the 784 repairs that met the inclusion criteria, 639 (81.5%) were single-incision approaches. When comparing double-incision and single-incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs 0.8%, P = .010), heterotopic bone formation (7.6% vs 2.7%, P = .004), and reoperation (8.3% vs 2.3%, P < .001). The most common nerve complication encountered was a lateral antebrachial cutaneous nerve palsy (n = 162), which was significantly more common in the single-incision repairs than in the double-incision repairs (24.4% vs 4.1%, P < .001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single-incision and double-incision (5.8% vs 6.9%, P = .612). The overall rate of tendon rerupture was 1.9% (single incision, 1.6%; double incision, 2.8%; P = .327). The overall rate of postoperative wound infection was 1.5% (single incision, 1.3%; double incision, 2.8%; P = .182). The average time from surgery to release from medical care was 14.4 weeks (single incision, 14 weeks; double incision, 16 weeks; P = .286). Patients treated with cortical button plus interference screw were released significantly sooner than were patients with other single-incision repair types (13.1 ± 8.01 weeks, P = .011). There were no significant differences in rates of motor neurapraxia, infection, rerupture, and reoperation with regard to surgeon’s years of practice, fellowship training, or case volume. Conclusion: The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, the double-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and reoperation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications.

Intramedullary Cortical Button Fixation Of Distal Biceps Tendon Rupture: Long-term Patient Outcomes

Objectives:No consensus currently exists for optimal distal biceps rupture fixation. Dorsal cortical button (DCB) and dual incision transosseous (DITO) provide the greatest biomechanical load-to-failure, permitting earlier mobilization to prevent arthrofibrosis. Both methods have associated complications, restricted range of motion (ROM) from heterotopic ossification and proximal radioulnar synostosis for DITO while DCB has increased incidence of cutaneous and posterior interosseous nerve (PIN) injuries despite different techniques to reduce their frequency. The intramedullary cortical button (ICB) fixation technique aims to decrease PIN palsy risk, decrease implant costs and provide strong tendon-bone fixation allow for early ROM. We set out to determine the long-term efficacy of this technique and any difference in complication rates including re-rupture.Methods:31 patients underwent ICB fixation of chronic and acute distal biceps tendon ruptures without allograft with more than 1 year follow up. 21 patients completed a questionnaire and Disabilities of the Arm, Shoulder and Hand (DASH) survey. Elbow and forearm ROM, cosmesis, pain, strength, motor nerve neuropraxia, cutaneous sensory changes and other complications were obtained from the chart and questionnaire. The ICB technique utilizes a 4cm transverse anterior incision 2cm distal to the distal antecubital flexion crease. The tuberosity is prepared, creating a clean, bleeding bony surface. A #2 high-strength braided suture is passed through the toggle hole at both ends of a Smith and Nephew Endobutton. A needle passes one suture pair in the 4.7mm hole and out the 2mm hole drilled with mild convergence in the distal and proximal tuberosity footprint with a 1.5cm bony bridge. This suture pair shuttles the Endobutton into the intramedullary canal, both limbs of each suture exits their respective hole. One limb from each suture is whipstitched proximally and back distally. Tensioning the free suture limb exiting the 2mm hole and tying to its free suture pair compresses the biceps stump against the radial tuberosity and secures the Endobutton against the intramedullary cortex at the 2mm hole. Finally the free suture limb exiting the 4.7mm hole is tensioned and tied to its suture pair limb, distributing tendon compression over the entire tuberosity footprint.Results:At an average of 4 (1.3-7.4) years postoperatively, 81% were extremely and 10% very satisfied with their overall outcome. 81% reported no strength or ROM limitations, 76% had pain-free activity, 86% and 81% were extremely satisfied with postoperative elbow ROM and forearm ROM respectively. The mean DASH and sports DASH score were 3.52 and 2.5. Transient sensory changes were noted in the lateral antebrachial cutaneous nerve and superficial radial nerve distributions in 38% and 19% of patients respectively. Excluding workers compensation patients improved the percent of extremely satisfied patients to 93% and the average DASH score to 0.93. No biceps re-ruptures or PIN palsies were observed.Conclusion:The ICB technique provides secure distal biceps tendon fixation with excellent long-term patient satisfaction and comparable functional outcomes to existing fixation techniques with restoration of normative DASH scores. The ICB technique has a cutaneous nerve complication rate comparable to other single incision studies and no observed PIN palsies or wound complications were noted while decreasing the implant costs.

Stepwise Percutaneous Leverage Technique to Avoid Posterior Interosseous Nerve Injury in Pediatric Radial Neck Fracture.

To introduce a stepwise percutaneous leverage technique to avoid posterior interosseous nerve (PIN) injury in pediatric patients with radial neck fractures and to evaluate the clinical outcome and the predisposing factors affecting the outcome. Retrospective case series study. University level 1 trauma center. Thirty-four children with a radial neck fracture, who were treated using a stepwise percutaneous leverage technique, were included in the study. The radial head fragment was reduced by pulling the first Steinmann pin proximally as a lever. Then, the kinked soft tissue was released by removal of the Steinmann pin with buttressing the radial head by the operator's thumb. The second Steinmann pin was inserted into relaxed soft tissue for fixation of the radial head. We used the Métaizeau classification as a radiologic result and Mayo Elbow Performance Score (MEPS) as a clinical outcome. Regression analysis was performed to identify the predisposing factors affecting the outcome. There was no occurrence of PIN palsy. According to the Métaizeau classification, 23 cases were classified as excellent, 9 as good, 1 as fair, and 1 as poor. The average MEPS was 97.6 points. Based on the regression analysis, only the postoperative Métaizeau classification was confirmed as a risk factor of a relatively poor outcome. The stepwise percutaneous leverage technique can be considered a good option in the treatment of pediatric radial neck fractures, because it ensures excellent results by avoiding injury to soft tissues including the PIN. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Giant-cell tumour of proximal radius in a 50-year-old female with wrist drop: a rare case report

Giant-cell tumour is a locally aggressive tumour of long bones of epiphyseal region commonly occurring in adults aged 20–40 years. Most common location is distal femur, proximal tibia, and distal radius. Different treatment options being used are curettage with bone graft or bone cement, resection with arthrodesis, reconstruction, radiation, and chemotherapy. We are reporting a case of giant-cell tumour of right proximal radius in a 50-year-old female with posterior interosseous nerve palsy. It is very rare, and only four cases have been reported in the literature. It was treated by wide margin resection with fibular grafting, titanium elastic nail system along with cancellous bone graft reconstruction.

Stability-based assessment of Monteggia-type injuries predicts failure of treatment.

Paediatric Monteggia-type injuries are complicated by treatment failure and posterior interosseous nerve palsy, without reliable predictive indicators. Outcome is considered to be good, with little patient-reported evidence. We propose novel radiographic parameters. A total of 33 Monteggia-type injuries were analysed. Posterior interosseous nerve palsy was strongly predicted by the Radial Head Displacement Index. The presence of two or more of three novel instability markers was associated strongly with treatment failure. Patient-reported outcome measures were almost uniformly excellent. We advocate the use of a new, inclusive, stability-based classification of Monteggia-type injuries to predict patients who require accurate internal fixation.

Bilateral Tardy Posterior Interosseous Palsy

We present a rare case of bilateral posterior interosseous nerve palsy secondary to congenital dislocation of the radial head in a 54-year-old male. After an initial trial of orthotic management, he had a successful outcome following a surgical decompression of the nerve on one side.

The radial head dislocation in children with posterior interosseous nerve paralysis—follow-up for 12 years—

The radial head dislocation in children with posterior interosseous nerve paralysis—follow-up for 12 years—

Nontraumatic “isolated” posterior interosseous nerve palsy: Reinterpretation of electrodiagnostic studies and MRIs

Different hypotheses have been proposed for the pathophysiology of posterior interosseous nerve (PIN) palsy, namely compression, nerve inflammation, and fascicular constriction. We hypothesized that critical reinterpretation of electrodiagnostic (EDX) studies and MRIs of patients with a diagnosis of PIN palsy could provide insight into the pathophysiology and treatment. We retrospectively reviewed patients with a diagnosis of nontraumatic PIN palsy and an upper extremity EDX and MRI. The original EDX studies and MRIs were reinterpreted by a neuromuscular neurologist and musculoskeletal radiologist, respectively, both blinded to our hypothesis. Fifteen patients met the inclusion criteria, i.e., having an "isolated" PIN palsy. Four patients (27%) had a defined mass compressing the PIN. The remaining 11 patients (73%) presented with at least one finding incompatible with the compression hypothesis: physical examination revealed that weakness in muscles was not innervated by the PIN in 4 patients (36%); EDX abnormalities not related to the PIN were found in 4 patients (36%); and reinterpretation of the MRIs showed muscle atrophy or nerve enlargement beyond the territory of the PIN in 9 patients (82%), without any evidence of compression of the PIN in the proximal forearm. The eleven patients in our series with presumed isolated and idiopathic PIN palsy had evidence of a more diffuse nerve-muscle involvement pattern, without any radiologic signs of nerve compression of the PIN itself. These data would favor an inflammatory pathophysiology when a structural lesion compressing the nerve is ruled out with imaging.

Posterior Interosseous Nerve Palsy Caused by Ganglion at the Edge of Supinator Muscle in Shoeshine Man. –A Case Report-

Posterior Interosseous Nerve Palsy Caused by Ganglion at the Edge of Supinator Muscle in Shoeshine Man. –A Case Report-

Partial Tears of the Distal Biceps Brachii Tendon: A Systematic Review of Surgical Outcomes

To systematically review the literature regarding surgical outcomes for treatment of partial tears of the distal biceps brachii tendon. This study was conducted in accordance with the Preferred Reporting Items for SystematicReview and Meta-Analysis guidelines. A systematic review of the literature regarding treatment of partial tears of the distal biceps tendon was conducted using PubMed, Embase, and Cochrane. Inclusion criteria consisted of studies in the English language on the treatment of partial distal biceps tendon tears. Exclusion criteria consisted of (1) studies without outcome data, (2) studies that did not specify the degree of distal biceps tendon tear (ie, complete rupture vs partial tear), and (3) studies without partial tear subgroup data. Two investigators independently reviewed the abstracts from all identified articles. Only 5 patients who underwent successful nonsurgical treatment were identified; all were treated with different algorithms, and because of the small number, outcomes for nonsurgical treatment are not included in this review. Therefore, 19 studies involving 86 partial tears that underwent surgical treatment are reported; at least 65 of these received a trial of nonsurgical treatment before surgery. Surgery resulted in 94% satisfactory clinical outcomes. Of the 16 studies (n= 83) that specified the presence or absence of surgical complications, lateral antebrachial cutaneous nerve paresthesia (17%), posterior interosseous nerve palsy (6%), elbow discomfort (2%), surgical revision (2%), and asymptomatic heterotopic ossification (1%) were reported. Surgical treatment including tendon tear completion and anatomic repair to the radial tuberosity can yield satisfactory results and appears to provide predictable outcomes. Further research is necessary to better define the optimal regimen and duration of nonsurgical treatment, as well as the indications for surgery. Therapeutic IV.

Cervical Spondylotic Amyotrophy

Keegan (1965) reported a patient who presented with "dissociated motor loss," an acute paralysis of the upper extremity with minimal sensory signs and no long tract signs, and documented an anterior root lesion following autopsy. Sobue et al. (1975) reported similar cases using the term "cervical spondylotic amyotrophy (CSA)," but postulated pathology of the anterior horn. Although Keegan's "dissociated motor loss" surely referred to isolated motor paresis with no or minimal sensory signs, contrary to existing criticism, a more general term, CSA, should be preferred. CSA is divided into proximal and distal types. Distal CSA often presents with a drop finger, and thus may be misdiagnosed as posterior interosseous nerve palsy. Documentation of the involvement of ulnar muscles by clinical signs and EMG would lead to the diagnosis of distal CSA. Proximal CSA may be confused with neuralgic amyotrophy (NA), although the sparing of the serratus anterior and the stereotypic involvement of deltoid, infraspinatus, biceps brachii, and brachioradialis suggest CSA. Cervical MRI is not diagnostic in around half of CSA cases, and denervation in paraspinal EMG is a more sensitive test that can exclude NA. Amyotrophic lateral sclerosis is another important differential diagnosis for CSA.

Distal biceps ruptures: open and endoscopic techniques.

Distal biceps tendon ruptures are relatively rare. Patients are usually middle-aged men involved in heavy labor. Patients usually present with the history of a pop and a proximal migration of the biceps muscle belly. Clinical exam should be sufficient to diagnose a complete rupture. Several specific tests have been described. Ultrasound scanning or MRI can help confirm the diagnosis. Radiographs are not needed to diagnose distal biceps tendon rupture but may show typical findings. Imaging, more specifically the flexion-abduction-supination (FABS) view MRI, is particularly helpful in the case of a partial rupture or chronic rupture of the distal biceps tendon. Results of surgical reinsertion of the distal biceps have been shown to be superior to conservative treatment. Different techniques and approaches have been described with specific advantages and disadvantages. Primary repair of the tendon is preferred. If this is no longer possible in chronic tears, an augmentation can be done using tendon graft. Results of surgical treatment are good in the vast majority of patients. Reruptures are rare but minor complications are common. Major complications may include posterior interosseous nerve palsy or radioulnar synostosis, but the risk of these complications may be decreased by meticulous attention to detail during surgery.

Iatrogenic Posterior Interosseous Nerve Palsy due to Open Reduction and Fixation of Radial Head and Neck Fractures

Iatrogenic Posterior Interosseous Nerve Palsy due to Open Reduction and Fixation of Radial Head and Neck Fractures

Frozen Autograft-Prosthesis Composite Reconstruction in Malignant Bone Tumors.

Several methods are available using an endoprosthesis or biological reconstruction for malignant bone tumors. Methods that use allograft-prosthesis composites have shown promising results. In 1999, the authors developed a method of reconstruction that uses a tumor-bearing autograft treated with liquid nitrogen. This technique was modified to produce a pedicle frozen autograft to maintain anatomical continuity on one side. In this study, the results of bone reconstructions using frozen autograft-prosthesis composites were retrospectively evaluated. The demographic data, histological records, surgical procedures, functional scores, and complications of 22 patients who had bone sarcoma or metastasis and at least 2 years of follow-up were reviewed. There were 19 patients with primary bone sarcoma and 3 with bone metastasis. Average age was 36 years (range, 9-73 years), and mean follow-up was 63 months (range, 24-176 months). Reconstructions were performed on 10 proximal femurs, 5 distal femurs, 4 proximal tibias, 1 proximal humerus, 1 proximal radius, and 1 hemipelvis. There were 12 pedicle-freezing and 10 free-freezing procedures. Union rate was 90% (9/10), and average union time was 9.5 months. Average Musculoskeletal Tumor Society score was 89.3%. Complications included 1 fracture, 2 infections, 3 soft tissue recurrences, and 1 posterior interosseous nerve palsy. The authors concluded that the frozen autograft-prosthesis composite demonstrated excellent Musculoskeletal Tumor Society scores, a low complication rate, and a good union rate and was superior when used with the pedicle-freezing technique.

Functional outcomes and complications after surgical repair of triceps tendon rupture.

The purpose of this study was to present the functional outcomes and complications after primary repair of triceps tendon ruptures (TTR). A retrospective review was performed on eight patients (six males, two females) who underwent transosseous suture repair for TTR. Mayo elbow score, range of motion, muscle strength and patient satisfaction were evaluated after at least 1-year follow-up. The mean age of the patients was 25.1 years (range 16-42). The mechanism of injury was a sports injury in three patients, simple fall (fall on outstretched hand) in four and motorcycle accident in one patient. Two patients had associated radial head fracture, and one had a radial head fracture and trochlear fracture, and one patient had a medial epicondyle fracture. In two patients the diagnosis was missed at the initial admission to ED (delay, 20 and 75 days). Only one patient, who was a bodybuilder, had a history of anabolic steroid use, and the rest had no underlying disease or a predisposing factor for TTR. One of the patients with radial head fracture (displaced three parts) underwent simultaneous fixation using two headless screws. Patients were followed up for a mean of 18.8 months (range 12-26). At the final follow-up, all patients were satisfied with the treatment and the Mayo elbow score was excellent in six patients and good in two patients. There was 5° extension loss in two patients. Triceps muscle strength was 5/5 in all patients. Ulnar nerve entrapment occurred in one patient, so ulnar nerve release and anterior transposition were performed 3 months after surgery. Posterior interosseous nerve palsy occurred in one patient who underwent simultaneous radial head fracture fixation, but eventually returned back to normal 3 months postoperatively. All patients returned to their previous level of activity and occupation. Transosseous suture technique is a safe and effective treatment method for acute TTR with a low rate of complications and excellent functional outcomes. Retrospective case series, Level IV.

Percutaneous leverage reduction for severely displaced radial neck fractures in children.

To define the effectiveness of percutaneous pin leverage reduction for the severely displaced (angulated >60 degrees) radial neck fracture in children. Between 1997 and 2011, a series of 12 severely displaced radial neck fractures of 73 radial neck fractures in children was prospectively analyzed. Twelve children with fractures angulated >60 degrees and those who were followed up for >1 year were evaluated. Angulation and translation of fractures were measured through anteroposterior, lateral, and both oblique radiographs of the injured elbow. In all the cases, fractures were reduced with the percutaneous pin leverage technique followed by advancing of the pin and application of a long arm cast. We analyzed radiographs and clinical results by criteria suggested by Metaizeau. There were 3 boys and 9 girls, with a mean age of 8 years (range, 4 to 13 y). The mean angulation of the fractures was 68 degrees (range, 60 to 90 degrees), and the mean translation was 90.8% (range, 60% to 100%) at initial presentation. All fracture were reduced successfully and did not develop into angulation and translation of the fracture The mean follow-up period was 7 years and 4 months (range, 1 y 5 mo to 13 y 9 mo). Excellent results were observed in 7 and good results in 5 at the last follow-up. Transient posterior interosseous nerve palsy was observed in 1, and the patient recovered spontaneously at 2 weeks after the operation. Mild cubitus valgus deformity was observed in 1 patient at last follow-up. There were 12 consecutive cases with angulation of >60 degrees, and all of them were successfully reduced and obtained excellent or good result. Percutaneous pin leverage reduction followed by fixation with advancing of the pin is a safe and effective method to treat severely displaced radial neck fractures (>60 degrees) without serious complications. Level III--therapeutic.