Radial Neck Fractures In Children Research Articles

Surgical treatment of displaced radial neck fractures in children with metaizeau technique: Late-term results

Surgical treatment of displaced radial neck fractures in children with metaizeau technique: Late-term results

Outcome of open reduction and Kirschner wire fixation in pediatric radial neck fracture.

BackgroundRadial neck fracture in children is rare. This study attempted to evaluate the outcome of surgically treated patients and any associated complications.MethodsThis study evaluated 23 children under 15 years of age with radial neck fracture who were treated with open reduction between 2006 and 2016 to determine their range of motion, postoperative complications, and radiographic outcomes. The results were assessed clinically using the Mayo clinic elbow performance score.ResultsThe mean follow-up duration for patients was 34.6 months. The average postoperative angulation was 3.6º. Hypoesthesia was reported in only 9% of patients, and none of the patients complained of postoperative pain. The postoperative X-ray results were excellent in 60% and good in 40%. No radiographic complications were identified. The elbow score was excellent in 87% and good in 13% (mean score, 96.74). There was a statistical relationship between range of motion limitations and age, degree of fracture, initial displacement, and surgical pin removal time.ConclusionsAlthough most patients accept the closed reduction method as a primary treatment, the present study suggests that an open-reduction approach has been associated with optimal therapeutic outcomes for patients in whom closed reduction was not satisfactory or indicated.

Comparison of different treatments for children with radial neck fracture and analysis of prognostic factors

IntroductionThe aim of this was to analyze the effect of different treatment options on radial neck fractures in children and to explore the factors affecting the prognosis of fractures.MethodsThe clinical data of 131 children with radial neck fractures admitted to our hospital from 2010 to 2018 were retrospectively analyzed, and the patients were divided into 6 groups according to treatment methods [manual reduction with Kirschner wires (K-wires) for internal fixation (group A); manual reduction with elastic stable intramedullary nails (ESINs) for internal fixation (group B); leverage reduction with K-wires for internal fixation (group C); leverage reduction with ESINs for internal fixation (group D); manual and leverage reduction with K-wires/ESINs for internal fixation (group E); and open reduction with K-wires/ESINs for internal fixation (group F)]. Postoperative elbow function and complications were analyzed.ResultsAmong the 131 patients with fractures, the median age was 8 years, the median preoperative angulation was 52°, the follow-up rate was 86.3% (113/131), the average follow-up time was 58.3 months, and the postoperative complication rate was 17.7% (20/113). The comparison among the different treatment groups showed that group B had the best recovery of elbow function, postoperatively, and the lowest postoperative complication rate. Age, duration of hospitalization, and preoperative angulation were independent factors affecting postoperative complications. Older age, longer duration of hospitalization, and higher angulation increase the postoperative complications.ConclusionDifferent treatment options have different efficacies for radial neck fractures in children, of which manipulative reduction with internal fixation using ESINs can achieve good efficacy and a low postoperative complication rate. Age, duration of hospitalization, and preoperative angulation are independent factors for postoperative complications.

Radiological and functional outcomes of modified Metaizeau technique in displaced radial neck fractures

The management of displaced radial neck fractures in children is still a controversial topic. The objective of this study is to examine the outcomes of modified Metaizeau technique in the children with displaced radius neck fractures. The retrospective study included 15 children with displaced radial neck fracture with an angulation of more than 30° who were managed with the use of leverage technique by mosquito clamps and internal fixation with elastic stable intramedullary nailing (ESIN). Radiological and functional assessments were performed during follow-up. Additionally, the patients were evaluated using Mayo Elbow Per- formance Score (MEPS). All the children could be managed with clamp-assisted closed reduction. The average duration of follow up was 25.5 ± 6.1 months (15-36 months). An excellent elbow function was achieved in all but one patient. Based on Metaizeau classification, excellent, good, fair, and poor outcomes were achieved in 11, 1, 2, and 1 patients, respectively. The average postoperative MEPS score was 98.7 ± 5.1 (80-100). Clamp-assisted closed reduction and fixation with ESIN is a good choice in the children with displaced radial neck fractures. This technique is associated with good functional and radiologic outcomes in the medium-term. Further studies are warranted with larger sample sizes.

Open reduction of radial neck fractures in children: injury severity predicts the radiographic and clinical outcomes.

Radial neck fractures are the third most common elbow fracture in children. Open reduction may be required if closed or mini-open techniques are not successful in reducing the fracture. Previous reports on open reduction have noted poor outcomes and complications with this treatment approach. However, it is unknown whether it is the open procedure itself or the severity of the initial injury that leads to the poor results. The purpose of this study was to evaluate the correlation between intraoperative findings at the time of open reduction of radial neck fractures and the clinical and radiographic outcomes. Data from patients who underwent open reduction for an acute radial neck fracture between January 2009 and December 2018 were abstracted and reviewed. Patients undergoing open treatment for a nonunion or malunion and those with inadequate follow-up were excluded. Demographic data, injury characteristics, treatment strategies, intraoperative findings, and clinical and radiographic outcomes were assessed. Twenty-two patients met the inclusion criteria. Of these patients, 14 were girls. The mean age was 9.7 ± 3 years, and the mean follow-up period was 15.8 months. Fifteen patients had a Judet grade IV displacement. Fair or poor outcomes were observed in 12 patients (55%). Ten reoperations were recorded during the study period. Age, weight, and associated injuries were not predictive of poor outcomes. Intraoperative findings of soft-tissue stripping and radial head comminution were the only significant predictors of fair or poor clinical outcomes (P < .001) and subsequent radiographic changes including fragmentation and collapse of the radial head and arthritic changes (P < .001). The quality of reduction and the choice of hardware were not significantly associated with either clinical or radiographic outcomes. Our findings support the notion that the outcomes of open reduction of radial neck fractures are most closely correlated with the injury severity, with the intraoperative findings of complete soft-tissue stripping or comminution of the radial head fragment being significant predictors of poor clinical and radiographic outcomes. The choice of hardware and the quality of reduction achieved at the time of surgery have less significance than injury severity.

Radial neck fractures in children

Radial neck fractures in children

Flexible intramedullary nailing for radial neck fractures in children

The aim of this study was to analyze the outcomes of treatment and the rate of complications in children treated with flexible intramedullary nailing (FIN) for radial neck fractures. The study included 26 children (11 males and 15 females) with a median age of 9.5 years, treated with FIN for the radial neck fractures between May 2011 and May 2018. Immobilization after the surgery was not used. The median follow-up was 41 months. According to the Judet classification, 15 fractures were classified as type III and 11 as Type IV. For each patient, clinical, radiological, and disability of the arm, shoulder, and hand (DASH) scores were calculated. All patients achieved complete radiographic healing at a median of 5 weeks. The nails were removed at a median of 4 months. The rate of complications was 11.5%, including 1 radial head necrosis, 1 angulation of 15°, and 1 displacement of the radial head. Twenty patients (76.9%) achieved a perfect clinical healing, while 23 patients (88.5%) achieved a perfect radiological healing. The median DASH score was 1.25. No cases of delayed healing were recorded. After removing of the nails, all patients returned to full function of the extremity and all complications were resolved. The use of FIN for treating fractures of the radial neck in children shows very good functional and cosmetic results. It allows mobilization with rapid pain reduction. It is a minimally invasive, simple, and reproducible technique with a low rate of complication. Owing to excellent results, surgical stabilization of radial head and neck fractures using FIN is recommended in children and adolescents. Level IV, Therapeutic study.

Treatment Outcome of Métaizeau Technique of Intramedullary Pinning in Pediatric Displaced Radial Neck Fracture

Introduction: Displaced radial neck fracture in children when poorly managed results in deformity of elbow and incapacitates patient’s daily activities due to compromised forearm motion, hence they require careful attention. Aims: The aim of this study is to assess the outcome of Métaizeau Technique in displaced radial neck fracture in Children. Methods: This hospital based study evaluated the treatment outcome of 35 patients with an average age of 9.34 years (range, 6 – 14 years), who presented with displaced radial neck fracture; and were treated by Métaizeau technique of intramedullary pinning by Kirschners (K) wire at Nepalgunj Medical College, Kohalpur from April 2017 to January 2020. Only Judet’s type 3 and 4 fractures were included in this study. Close reduction was attempted in all cases. All patients were followed up for an average of 8.4 months (range, 6-12 months). Functional outcome was assessed as per Métaizeau functional score. Results: All fractures united at an average of 3.77 0.84 months (meanSD). Twenty seven patients had type 3 fracture and remaining 8 had type 4a fracture. Twenty five (92.5%) patients with type 3 fracture exhibited excellent results; while three patients (37.5%) with type 4a fracture had excellent outcome. Closed reduction produced excellent outcome in all patients while 80.95% patients with percutaneous reduction had excellent result. Conclusion: Outcome depends on initial fracture type and mode of reduction. Closed reduction should be preferred over an open reduction in order to achieve superior outcome.

Prognostic factors for intramedullary nailing in radial neck fracture in children

IntroductionRadial fracture accounts for 1% of fractures in children. It is potentially serious, and treatment is controversial. Several studies assessed prognostic factors, only one of which used exclusive intramedullary nailing, despite this being the gold standard. HypothesisOpen surgery provides poor functional results in radial neck fracture. Material and methodAll patients undergoing reduction and internal fixation of radial neck fracture between 2005 and 2015 were analysed. Inclusion criteria comprised Jeffery type 1 fracture with open growth plate, complete file, and ≥1 year's follow-up. Treatment systematically comprised Métaizeau intramedullary nailing, with crossover to open reduction only in case of failure. Good results were defined as full range of motion and pain-free elbow. ResultsFifty-six patients were included: 33 girls, 23 boys; mean age, 9 years. On the Judet classification modified by Métaizeau, 4 fractures were grade 2, 29 grade 3, 15 grade 4A and 8 grade 4B. Closed reduction was performed in 48 cases, including 8 with the help of percutaneous leverage effect. Eight required a surgical approach. Twenty-three showed postoperative reduction defect. At a mean 74 months’ follow-up, at a mean age of 15 years, 37 patients had reached full skeletal maturity. Sixteen had poor results. Open reduction was associated with poor outcome (p<0.01). Age, initial epiphyseal tilt, associated lesions, immobilisation time, time to nail removal and residual tilt after reduction did not significantly affect outcome (p-values>0.05). Percutaneous leverage effect had no impact on the quality of results (p=1). DiscussionOpen reduction is to be avoided in radial neck fracture. A prospective study is needed to assess remodelling potential according to age. Level of evidenceIV, retrospective study.

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

Radial neck fractures account for 5-10% of paediatric elbow trauma. Radial neck fractures have been classified by Judet into five types (I-IVb). There is a global agreement to reduce radial neck fractures with angulation more than 30° (Type III, IVa and IVb). Various maneuvers have been described but none of them uniformly achieved complete reduction in severely displaced radial neck fractures (Type IVa and Type IVb Judet). In this case series, we are presenting our experience with close reduction of ten severely displaced paediatric radial neck fractures to achieve complete anatomical reduction. We attempted close reduction in ten consecutive children with average age of 8.59 ± 1.68years (range, 6-12years) who presented with severely displaced radial neck fracture (Type IVa and IVb Judet). There were five girls. All patients had close injuries and presented to us within 24-48h. One of the patients had associated undisplaced lateral condyle fracture. We have excluded two patients with associated elbow dislocation. Close reduction was performed within 48h of initial injury. We were able to obtain complete anatomical reduction in all of our patients with this technique. None of the patients required fixation of fracture. At 1year of follow-up, (12 ± 2.07months, range 9-16months) all patients demonstrated almost full range of elbow and forearm motion. Final radiographs revealed complete union without any evidence of avascular necrosis. This technique offers an option of close reduction for the most severely displaced radial neck fractures, which were otherwise being treated by surgical intervention. The online version of this article (10.1007/s43465-020-00168-6) contains supplementary material, which is available to authorized users.

Arthroscopically-assisted reduction and pinning of a radial neck fracture in a child: a case report and review of the literature

BackgroundDisplaced radial neck fractures in children are challenging to treat. The age of the patient and the degree of angulation are the main criteria to consider when managing these fractures in children. Various surgical techniques have been described in the literature for both indirect and direct reduction and for fixation. However, the best treatment is still debated.Case presentationThe case presented is of a 6-year-old Caucasian boy with an impacted and displaced radial neck fracture. With the patient in lateral position, under general anesthesia, elbow arthroscopy was performed to better visualize the articular surface and to assist with reduction and fixation. The fracture was reduced and fixed with a single K-wire under direct arthroscopic visualization. No associated lesions were found. An above-elbow cast was applied after surgery. The cast and K-wire were removed 3 weeks later. At the 3-month follow-up, the patient showed a full recovery with complete range of movement without any postoperative and radiographic complications.ConclusionTraditionally, surgery for displaced radial neck fractures in children is performed by closed reduction with percutaneous pinning or elastic intramedullary nail fixation under fluoroscopic guidance. Direct visualization of the articular surface via an open approach allows better reduction in complex fracture patterns but is related to a higher risk of complications: elbow stiffness, instability, or avascular necrosis. Elbow arthroscopy in children could be a valid alternative to open fixation surgery for displaced radial neck fractures without the complications associated with articular exposure, allowing the direct visualization of the fracture and reducing radiation exposure. Although technically demanding, we believe elbow arthroscopy should be considered an alternative option because it is effective in assisting reduction and fixation and enables the detection of associated joint lesions.

Treatment principles, prognostic factors and controversies in radial neck fractures in children: A systematic review

IntroductionRadial Neck fractures are rare injuries in children. There is controversy surrounding their prognosis and management. AimsThis review aims to produce an up-to-date summary to clarify prognostic factors and management principles, in the light of recent, better-quality evidence. MethodsA systematic review was undertaken in accordance to PRISMA guidelines, applying pre-defined selection criteria. 6 papers were found suitable after quality assessment. All were observational cohort studies, one prospective and the rest retrospective. A semi-qualitative review was undertaken as heterogeneity, especially in the fracture classification and outcome assessment tools used, prevented quantitative synthesis. ResultsMajority of these fractures occur at the metaphysis. Consistently good results are seen with simple immobilization in fractures angulated<30° with translation<50%, with nearly all achieving a good outcome. In more displaced fractures, results are poorer and only about 70% patients achieve a good outcome. Both higher fracture displacement and more invasive treatment are associated with worse outcomes, but also with each other. Associated injuries are common, with Proximal Ulna fractures being commonest (71%), but their effect on outcomes is unclear. Age more than 10 years is associated with worse displacement, more invasive treatment and worse results. There is much confounding among all these factors which remains to be convincingly addressed. An algorithmic approach is advisable for these fractures, with stepwise application of more invasive treatment only if less invasive methods fail. Percutaneous fixation with either K-wires or retrograde intramedullary elastic nails is acceptable. Fractures reduced closed in theatre fare better if fixed percutaneously to prevent re-displacement. Open treatment should be considered only if the fracture can’t be reduced to within the displacement limits of angulation<30° and translation<50%. Incidence of serious complications is generally low (3–5%), but their effect on outcomes is unclear. ConclusionsThe treatment of higher-grade radial neck fractures is still controversial, needing further research, possibly through multi-center prospective data collection in pediatric fracture registries using validated outcome measures.

Percutaneous leverage technique for reduction of radial neck fractures in children: technical tips.

PurposePaediatric radial neck fractures are challenging to treat. Multiple strategies exist for reduction and fixation; there is no clear consensus on the best surgical technique to achieve reduction. The percutaneous leverage technique is a method for reduction of radial neck fractures that has previously been described by Wallace, though there is a lack of published literature on this technique. We present a technical note and a modest case series on our modification to the percutaneous leverage technique accompanied by intramedullary fixation.MethodsWe describe a retrospective series of patients who underwent the modified percutaneous leverage technique for paediatric radial neck fracture reduction followed by flexible intramedullary nail fixation at a single Level I trauma centre from 2008 to 2016. This technique involves making a small incision over the dorsal border of the ulna and using a blunt curved surgical forceps to dissect towards the ulnar border of the radius just distal to the radial neck fracture site. The curved forceps is then used to push the radial shaft away from the ulnar shaft which reduces the radial neck fracture. Intramedullary fixation is then utilized to stabilize the reduction. Pre- and postoperative radiographs and clinical data from the medical record were reviewed, and patient, injury and treatment characteristics as well as complication rates are summarized.ResultsWe successfully treated a series of eight radial neck fractures with the modified percutaneous leverage technique. This technique allows for a small incision and a minimally invasive method for the reduction of paediatric radial neck fractures. This allowed for subsequent intramedullary fixation and early postoperative elbow mobilization. In our series, no patients developed synostoses or sustained peripheral nerve injuries using this technique.ConclusionThe modified percutaneous leverage technique followed by intramedullary fixation is a safe and effective technique for fixation of displaced paediatric radial neck fractures.Level of EvidenceLevel IV

Percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation of angulated radial neck fractures in children.

To describe clinical and radiographic outcomes after surgical management of angulated radial neck fracture in children. Twenty children (aged 2-11years) with angulated radial neck fracture with more than 30° angulations (Judet type III and IV fractures) were retrospectively reviewed. All the enrolled patients were surgically treated with percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation. Clinical outcomes were evaluated using Tibone and Stoltz score and the Mayo Elbow Performance Score (MEPS). Radiographic outcomes were evaluated with Métaizeau score. Complications were also evaluated. At a mean follow-up of 20months, no patients showed axial deformity of the upper limb or instability of the elbow. The mean value of the MEPS was 99.2, and excellent clinical results were achieved in 14 patients (73.7%) at Tibone and Stoltz score. The final X-rays showed fracture healing in all patients; furthermore, 75% of patients showed excellent reduction at Métaizeau score. No patient developed complication. There were no iatrogenic nerve injuries or pin infections. The results demonstrate that percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation of angulated radial neck fracture treatment is a simple, effective, rapid and inexpensive procedure. IV (case series and systematic review of level IV studies).

Management of Severely Displaced Radial Neck Fractures in Children: A Systematic Review and Meta-analysis of Outcomes.

This systematic review is an attempt to provide an evidence-based analysis of literature on management of severely displaced radial neck fractures (with > 60° displacement) in children. A systematic literature search was conducted to identify all original articles published between 01/01/1999 and 20/01/17 on surgical treatment of radial neck fractures in children in the following databases: MEDLINE, EMBASE, and CINAHL PLUS. Studies reporting pre-operative fracture displacement and post-operative outcomes according to standard outcome measures were included. Out of 887 studies identified on initial search, 48 were eligible for full-text review and 14 studies with a total of 173 patients were included in the final review. The overall success rate after severely displaced radial neck fractures in skeletally immature patients was 87% (95% CI, 82%, 92%). Closed reduction methods reported higher success rate of 90% (95% CI, 85%, 95%) compared to open reduction methods 77% (95% CI, 63%, 89%). The average rate of patients achieving excellent/good outcomes following surgical management after severely displaced radial neck fractures in this review is better than reports from previous reviews. Considering the limitations in current evidence base including lack of direct comparison of techniques and small study samples, large comparative studies controlling for possible confounders are merited.

Radial neck fracture in children: anatomic and functional results of Metaizeau technique.

Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children.

Closed reduction of severely displaced radial neck fractures in children

BackgroundSeverely displaced radial neck fractures in skeletally immature children are rare and can be difficult to reduce. The purpose of this study is to evaluate the results using our reduction maneuver.MethodsFrom October 2011 to December 2015, 26 children with radial neck fractures(O’Brien type II, III and Judet type III, IV) were treated at our institute. All patients underwent percutaneous K-wire leverage and radial intramedullary pinning in an average surgery time of 35 mins (15–80 min). The injured arm was immobilized at the functional position with plaster for 4–6 weeks, evaluated clinically and radiologically. The Metaizeau classification and Mayo elbow performance score were used to evaluate the radiological and clinical results, respectively. Percutaneous K-wire leverage and radial intramedullary pinning were performed for 26 patients. No patients were treated with open reduction. Twenty four patients were followed up for a mean of 33 (range 12–53 months) months.ResultsThere were 15 girls and 9 boys with ages ranging from 1.5 to 12 years and an average age of 7.2 years. Percutaneous K-wire leverage reduction and intramedullary pinning were successfully used in an average total surgery time of 35 mins (range 15–80 min). In total, 2 cases (O’Brien type III and Judet type IVb, angulation = 90°) needed the additional maneuver. Bone union was achieved in all patients within a mean time of 4.2 weeks. The clinical results were evaluated basing on the Mayo elbow performance score, and there were 23 excellent results and one good result. There were no refractures and no incidences of nonunion, suture infection, iatrogenic radial nerve injury, asymptomatic enlargements of the radial head or growth arrest in the proximal radial epiphysis.ConclusionOur modified percutaneous leverage technique with radial intramedullary fixation may be successfully used to avoid open reduction.

Radial neck fractures in children: A surgical tip using the Metaizeau technique to improve stability of the reduction

AimTo evaluate early results of management of radial neck fractures with Métaizeau technique in the paediatric age group and to elaborate on a surgical tip to improve stability of the fixation. MethodA retrospective analysis of 21 patients, with fracture radial neck, who underwent closed reduction and internal fixation with elastic intramedullary nailing (Métaizeau technique), was performed. Mean age at injury was eight years, and the average follow-up was 4.5 months (range: 3–6 months). Follow up Clinical and radiological evaluation was performed at first and sixth postoperative weeks. At six weeks following removal of the nail, a clinical assessment was conducted to record the outcomes, and any later follow-up was arranged based on pain and range of motion. ResultsWe recorded five excellent, eight good, one fair, results for type 3 fractures. For type 4 fractures, we had one excellent, five good and one fair, results. Altogether, we recorded 20 (90.5%) excellent or good results, and 2 (9.5%) fair results. Complications noted were superficial skin infection at the entry site in one patient that required a course of oral antibiotics. Prominent metal work was noticed in 14 cases, which didn't need any further intervention as it did not cause any functional discomfort. ConclusionWith Metaizeau technique, there were reported poor results of about 10% in literature. In our study, with the modification of the shape of the nail tip, we have managed to achieve stable fixation of the reduction without any loss of position and consequently, better outcomes.

Application of elbow arthrography in the treatment of severe radial neck fractures in children under 6 years old

Objective To introduce the application value of elbow arthrography in severe radial neck fractures in children younger than 6 years old and to summarize its clinical efficacy. Methods From May 2012 to December 2016, 18 children under 6 years old with severe radial neck fractures were treated in our hospital, including 11 males and 7 females, aged 40 to 70 months, with an average of 59.7 months. The preoperative radiographs did not show any obvious ossification center and only a thin bone slice displaced from metaphysis could be seen. According to O'Brien classification, there were 8 cases of type Ⅱ and 10 cases of type Ⅲ. Under anesthesia, routine lateral elbow arthrography and manual reduction with Metaizeau technique were conducted. If manual reduction is unsatisfactory, percutaneous pin prying reduction with Metaizeau technique or open reduction was conducted. After the operation, the long arm plaster was used for fixation for 4 weeks. Postoperative evaluation was based on Tibone and Stotz scoring system. Radial head ischemic necrosis, epiphyseal premature closure, intra-articular calcification and joint fusion were evaluated by X-ray films of the healthy and the injured side. Results One child had minor skin allergy during operation, and the others did not have adverse effects. Elbow arthrography can clearly reveal the articular surface and the degree of fracture displacement. All the patients were successfully repositioned by closed and/or pin prying reduction without open reduction. X-ray examination showed that the fracture healed well. There was no malunion at the fracture site, no premature epiphyseal closure and necrosis of the radius head. According to Tibone and Stotz criteria, 13 cases were excellent and 4 cases were good. Conclusion The intraoperative arthrography can provide a clear judgment of the displacement degree of fracture and evaluation of reduction quality for the patients with severe radial neck fractures under 6 years old. The method is simple and effective, and the clinical effect is satisfactory. It is worth promoting. Key words: Fractures,bone; Child; Arthrography; Metaizeau technique

Modified Metaizeau's technique for the treatment of radial neck fractures of Judet III or IV in children

To explore the clinical effect of modified Metaizeau's technique for radial neck fractures of Judet II or IV in children, summarizing the value of clinical application. From May 2014 to March 2017, 32 children of Judet III or IV radial neck fractures were treated with percutaneous Kirschner wire poking reduction and closed reduction with elastic intramedullary nailing fixation, including 21 boys and 11 girls, aged from 5.7 to 10.6 years old with a mean of 7.2 years old. The modified An-Morrey functional rating index were used to evaluate elbow range of motion, myodynamia, stability, and pain preoperatively and 1 year postoperatively in all the patients. All patients were available for an average follow-up from 12 to 15 months. No complications such as incision infection, wire or nail tail irritation and avascular necrosis of radial head and epiphyses was occurred. The fracture achieved solid healing at 8 to 10 weeks after operation. The modified An and Morrey functional score improved from 58.69±5.80 before operation to 99.13±1.79 at 1 year after operation, there was obvious difference of scores between preoperative and postoperative at 1 year. Modified Metaizeau's technique is a reliable and good treatment for Judet III or IV radial neck fractures in children, which has advantages of few complication, minimal invasion, quick fracture union and good recovery of elbow joint.