Radial Neck Fractures In Children Research Articles

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.

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.

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.

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.

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.

Percutaneous K-wire reduction and cast immobilization for severely displaced radial neck fractures in children.

The purpose of this study was to compare outcomes between percutaneous K-wire reduction cast immobilization (PKRC) and percutaneous K-wire reduction elastic intramedullary nailing combined with cast immobilization (PKRNC) for the treatment of radial neck fractures in children. This was a retrospective analysis of 62 radial neck fractures in children treated with PKRC or PKRNC. Thirty-one children were treated with percutaneous K-wire reduction, K-wire removal after reduction, and cast immobilization while 31 radial neck fractures in controls were managed using PKRNC. There were no significant differences between PKRC and PKRNC with regard to preoperative angulation ( P = 0.556). The operation time in the PKRC group was significantly shorter than that of the PKRNC group ( P = 0.023). There was no significant difference in the displacement angle when compared between the two groups on the first day and 1 month after surgery ( P = 0.617, 0.72). The Mayo elbow performance score of the elbow joint function did not differ significantly between the two groups ( P = 0.587). Although the hospital stay was not significantly different between groups (4.81 ± 1.07 vs. 4.16 ± 1.59 days; P = 0.067), the PKRNC group required a second hospitalization to remove the elastic intramedullary nail 3 months after the operation. PKRC and PKRNC both achieved satisfactory outcomes for radial neck fractures in children. The operation time in the PKRC group was significantly lower than in the PKRNC group. PKRC does not require reoperation to remove internal fixation. Therefore, PKRC is recommended for radial neck fractures in children.

Effect analysis of different methods on radial neck fracture in children

To analyze the curative effect of varying treatment types in 75 pediatric cases of radial neck fracture and explore the prognosis-related factors. Clinical data of 75 children with radial neck fractures treated in our hospital from January 2015 to December 2016 were retrospectively collected. The relationship between age, fracture type, treatment method, X-ray examination after reduction, and prognosis was analyzed. Age was related to prognosis. The excellent and good rate of treatment was 89.25% for children with age ≤ 10 and 57.89% for children over 10 years old. The type of fracture was closely related to the curative effect, 95.0% of O’Brien type I fractures had good curative effects, and the excellent and good rates of O’Brien II type and III type fractures were 87.0 and 66.7%, respectively. According to the type of fracture, the excellent and good rate of patients treated with plaster fixation was the highest (96.42%), but the excellent and good rate was 72.3% in the patients who needed to be reduced by Kirschner wire or elastic intramedullary nail. Although open reduction is superior to closed reduction in imaging evaluation, the excellent and good rate is only 50%.The prognosis of children with radial neck fracture is related to age, type of fracture, and treatment method. In pediatric patients less than 10 years with light, shifted fractures, the excellent and good prognosis rate is higher with less operative intervention. We recommend treating patients with closed reduction and elastic nail fixation according to different fracture types.

Closed Reduction Technique for Severely Displaced Radial Neck Fractures in Children.

The described technique is useful for achieving closed reduction of severely displaced (i.e., Judet Type-III and IV) pediatric radial neck fractures. It is widely agreed that radial neck fractures with angulation of >30° should be reduced. Various maneuvers have been described, but none uniformly achieves complete reduction in severely displaced radial neck fractures (Types III and IV)1-4. The aim of the present technique is to achieve closed reduction in these severely displaced radial neck fractures without surgical instrumentation. A stepwise approach is described. First, the radial head is viewed in profile under an image intensifier so that it appears rectangular. Varus stress is applied at the medial aspect of the elbow by the assistant, and thumb pressure is applied at the radial head along the posterolateral aspect of the elbow. This results in partial reduction of the radial head. The elbow is then simultaneously flexed and pronated with continuous pressure over the radial head. This final step anatomically reduces the radial head, and hyperpronating the forearm locks it in the corrected position. Operative alternatives to this technique include intra-focal pin-assisted reduction to achieve closed reduction, the Métaizeau technique of achieving indirect closed reduction of the fracture with the aid of a TENS (Titanium Elastic Nailing System) nail, and open reduction5. Nonoperative techniques have also been described for use with Judet Type-II and III fractures, but not with the severely displaced types described in the present article. This technique takes into consideration the anatomy of the capsule and lateral collateral ligament complex. The biomechanical ligamentotaxis helps in achieving anatomic reduction of the radial head. Placing the forearm in pronation tightens the annular and lateral collateral ligaments and prevents redisplacement. There are potential complications with operative treatment, including the risk of nerve injury with percutaneous reduction techniques and the risks of osteonecrosis, premature epiphyseal fusion, and heterotopic ossification with open reduction. These complications can be avoided by the use of the presently described technique. This technique provided satisfactory clinical outcomes in our previous study6, with none of the 10 patients showing signs of growth disturbance, loss of reduction, or reported complications at 12 months. Terminal restriction of supination was observed in 1 patient. No patient had osteonecrosis or elbow deformity. No patient required conversion to an implant-assisted or open reduction procedure. The steps need to be followed sequentially as described in order to achieve an anatomical reduction.After achieving the reduction, it is necessary to keep the forearm in pronation to maintain the reduction with the aid of the lateral ligament complex.This technique may not work in complex fractures with elbow dislocation because of the lack of ligamentous integrity.In the final step, the elbow is pronated and flexed simultaneously, with sustained pressure over the radial head in order to obtain further correction. This is the most critical step of the technique because anatomic reduction of the partially reduced fracture is achieved at this time. Percut. = percutaneousAP = anteroposteriorCR = closed reductionORIF = open reduction and internal fixation.

The outcome of Radial Neck Fracture Treated with Closed/ Open Reduction and Retrograde Kirschner Wires Fixation in the Paediatric Age Group

Background Radial neck fractures in children are rare injuries, representing 1 to 5% of all elbow pediatric fractures. Most of them are non-displaced or slightly displaced and treated conservatively. Severely displaced or angulated radial neck fractures (Judet type III and IV fractures or O’Brien type III radial neck fractures) requires surgical treatment.&#x0D; Objective To study the clinical and radiological outcomes of fractures following closed or open reduction and percutaneous intramedullary stabilization of the displaced radial neck fracture in children.&#x0D; Method There were 24 children with displaced radial neck fracture Judet type II, III and IV fractures O’Brien type II, III who underwent closed reduction and retrograde intramedullary stabilization with Kirschner wires. Functional outcomes were evaluated based on of Mayo Elbow Performance Score.&#x0D; Result The mean age of patients was 8.42 ± 1.82 years with boys 15(62.5%) and girls 9(37.5%) in number. An excellent result was seen in 5(20.8%) cases and good results in 15(62.5%) cases according to the Mayo elbow performance score. Analyzing a passive and active range of motion, 5 had excellent results, 15 had good results and 4 had fair results compared to the normal side. Radiological evaluation showed fracture healing in excellent or good alignment according to Ursei radiological evaluation classification.&#x0D; Conclusion Closed reduction and retrograde intramedullary Kirschner wires stabilization for the displaced radial neck fracture provide excellent clinical and radiological results with few complications.

A retrospective review of 101 operatively treated radial neck fractures in children and analysis of risk factors for functional outcomes

IntroductionRadial neck fracture is a less common injury in childhood and many factors are associated with the final functional outcomes. This study aimed to describe the clinical and radiological results of the patients with radial neck fractures treated surgically and assess the potential risk factors for poor functional outcomes. Patients and MethodsThis study enrolled 101 children with radial neck fracture and treated surgically at our department. Patients were followed up at least three years and assessed clinically and radiographically. The primary outcome of this study was the functional outcome assessed by using Metaizeau criteria and the secondary outcome was complications of radial head necrosis, postoperative radial nerve palsy, bone union, infection, and skin irritation. Related risk factors for unsatisfactory functional outcomes were recorded and analyzed by multivariable logistic regression. ResultsIn total, 101 patients with 101 elbows (44 on the left side, 57 on the right side) were evaluated in our study, including 55 females (54.5%) and 46 males (45.5%), with a mean age of 7.5±2.7 years old (range, 3 to 14 years). There were 65.3% excellent (66 cases), 18.8% good (19 cases), 11.9% fair (12 cases), and 4.0% bad (4 cases) results in these patients. The rate of satisfactory outcome was 65.3% (66/101) and the rate of “unsatisfactory outcome” was 34.7% (35/101). Complications included postoperative radial nerve palsies in 15 cases (14.9%), radial head necrosis in 4 cases (4.0%), skin irritation due to the nail-end in 5 cases (5.0%), infection in 2 cases (2.0%), and bone nonunion in 1 patient (1.0%). Only Judet type (OR, 5.78; CI, 1.72-19.39, p=0.005) and surgical method (OR, 12.68; CI, 2.55-63.06, p=0.002) were independent risk factors for the unsatisfactory functional outcomes. ConclusionsClosed reduction with intramedullary fixation is a primary treatment for type III and IV radial neck fractures in children. Fracture severity classified as Judet type IV and open surgical method were independent predictors for unsatisfactory functional outcomes.

Open Reduction of Displaced Radial Neck Fractures in Children by Internal Fixation Techniques: Comparison of Percutaneous Kirschner Wiring and Elastic Stable Intramedullary Nailing.

Although most paediatric radial neck fractures can be treated with closed reduction, some severely displaced fractures require open reduction. The purpose of this study is to compare the effects of ESIN and KW fixation in open reduction of radial neck fracture in children. Twenty-four patients with mean age of 8.5years were included. Four of the patients had a Judet type III fracture and 20 had a Judet type IV fracture. Ten patients who underwent percutaneous KW fixation were assigned to group A, while 14 patients who underwent ESIN fixation were assigned to group B. Variables of interest included age, sex, fracture type, associated lesions, surgical time, fracture reduction, cost, follow-up, healing time, X-rays, clinical outcomes, and complications. There were no significant between-group differences in sex, age, additional injuries, fracture type, and quality of reduction. Costs were significantly lower in Group A. Fracture healing was achieved in 23 of 24 patients (10/10 in group A and 13/14 in group B). In a postoperative elbow function assessment based on the Steele and Graham classification, 80% of patients in group A had a score of excellent or good, compared to 78.6% of patients in group B. Two cases of nail shifting and joint protrusion were observed in group B, one of which also presented with nonunion during follow-up. Both KW and ESIN may achieve good clinical outcomes, but KW is associated with lower costs, easier implant removal (without the need for a secondary surgery), and lower iatrogenic complications.