Radial Neck In Children Research Articles

Nonunion of the radial neck in children: a rare but severe complication after fractures of the radial neck

Nonunion of the radial neck poses an enormous challenge for treating surgeons. It is a very rare complication of the radial neck with limited experiences. In this current major study, the authors report of their own experiences concerning this problem. 11 patients with severe displaced radial neck fracture Metaizeau type IV with elbow dislocation and 2 ongoing fractures. 9 fractures had to be treated with open reduction, six with intramedullary nailing, two with K-wires and one with periosteal suture fixation. In two children, aged 4 and 5, the fracture was not diagnosed initially. The patients showed a successful reduction intraoperatively. All patients developed nonunion of the radial neck. 9 out of 11 children presented with pain and 5 out of 11 with valgus deformity. All children underwent surgical management of the complications. 3 children received a debridement of the elbow joint with resection of the fragmented radial head. 7 cases needed a following reduction, spongiosa-plasty and periosteal flap reconstruction and plate osteosynthesis. One patient received radial intramedullary pinning. All nonunions showed reunion. All patients with obtained radial head showed significant improvement concerning complaints and range of motion. Only one child showed a slight deterioration in range of motion. Children with resected radial head showed good range of motion but complaints and instability in loaded joint needing further surgical treatment. Treatment of radial neck nonunion in children should not be delayed until pain, deformity and limited function occurs because this goes along with severe transition of the radial head right up to bone atrophy.

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.

Percutaneous Reduction and Fixation Using Two K-wires In Paediatric Angulated Radial Neck Fractures.

Fractures of the radial neck in children are usually seen at about the age of five years, after the appearance of the proximal radial epiphysis. They are usually caused by a fall on the outstretched hand which produces a valgus strain [1]. Minor degrees of angulation can be accepted and treated conservatively, but advice on the maximum acceptable angulation varies widely, up to as much as 45°0 [2] More severely angulated and displaced fractures have been variously treated by closed or open reduction, but the precise indications for each are not clear [3]. In a retrospective study Steele et al. found that open reduction generally had a poor result and that open reduction with internal fixation was even worse, as has been reported by others [4, 5]. We describe a modified percutaneous technique using two (1.6mm) K-wires for reduction (one wire for leverage and one wire for translation) and two K-wires for rotationally stable fixation. Nine patients were included in the study. The median age of the patients was 9.6years. There were six males and three females. The average follow up period was 23months. The final results of the study included six patients with excellent results and one with a good result. Unfortunately, two patients were visitors and failed to attend for review. We have found this technique effective and easily reproducible. Level of evidence IV - Case series.

Post Closed Reduction Upside Down of Radial Head (180º Rotation) in Radial Head Fracture Dislocation-A Very Rare Case

Fracture of the radial neck in children is rare injury. Most of the injury presented in the causality treated by conservative methods. In two rare sub types of fractures of the radial neck associated with elbow dislocation, the head fragment is totally displaced from the neck. One attempt of closed reduction is mandatorily. We treated a displaced radial neck fracture with closed reduction method under image intensifier. Image intensifier picture was perfect and we took immediate post reduction X ray, which showed upside down of radial head, one of the rarest complication. We treated the patients with open reduction. So we should always keep in mind that 1800 rotation of radial head is potential complication of closed reduction and if left misdiagnosed it lead to elbow stiffness.

Children’s orthopaedics

The October 2012 Children’s orthopaedics Roundup360 looks at: magnetic growing rods and scoliosis correction; maintaining alignment after manipulation of a radial shaft fracture; Glaswegian children and swellings of obscure origin; long-term outcome of femoral derotation osteotomy in cerebral palsy; lower-leg fractures and compartment syndrome in children; fractures of the radial neck in children; management of the paediatric Monteggia fracture; and missing the dislocated hip in Western Australia.

Complete dislocation of the radial head following fracture of the radial neck in children: the Jeffery type II lesion.

The authors report four cases of Jeffery type 2 lesions in children. Despite the probable mechanism of such lesions, none of the cases reported here displayed a dislocation of the elbow. In the first observation the diagnosis was suspected only 15 days after injury. Two other cases were initially treated by closed external manipulations, one with percutaneous Kirschner wire leverage and the other with closed intramedullary pinning, but both cases displayed a 180 degree reversal of the radial head, suspected only secondarily. The first exhaustive review of the literature on the subject, shows that this complication is classical in Jeffery type 2 fractures. In fact none of the 22 cases described in the literature had successfully been reduced by external manipulations. Interposition of the lateral condyle, pathognomonic of the Jeffery type 2 fracture, hampers reduction. Attempts at reduction by external manipulation in nine cases therefore led to two non-reduction and seven reversal of the radial head. Knowledge of this particular fracture will allow an early diagnosis and an immediate surgical treatment.

Radial Neck Fractures in Children

Fractures of the radial neck in children are relatively rare. The outcome is dependent not only on the injury but also on the method of treatment and the presence of any associated injury. During the past 20 years, two new minimally invasive reduction techniques have been described in an attempt to improve the prognosis, and their results have been reported. A meta-analysis of the recent literature with the focus on outcome, and a management algorithm for this rare fracture are presented.

Radial Neck Fractures in Children

Fractures of the radial neck in children are relatively rare. The outcome is dependent not only on the injury but also on the method of treatment and the presence of any associated injury. During the past 20 years, two new minimally invasive reduction techniques have been described in an attempt to improve the prognosis, and their results have been reported. A meta-analysis of the recent literature with the focus on outcome, and a management algorithm for this rare fracture are presented.

Controversies regarding radial neck fractures in children.

Fractures of the radial neck in children are not uncommon, yet several aspects of their management remain controversial. Until a consensus is reached regarding the determination of displacement, acceptability of initial angulation, treatment, and outcome, the complication rate of these fractures will remain high. The authors recommend measuring the displacement as the angle between a line perpendicular to the articular surface of the radial head with a line down the shaft of the proximal radius. Fractures that are angulated less than 30 degrees require immobilization alone. Fractures angulated more than 30 degrees should be treated with an attempt at closed reduction. If closed reduction fails, a percutaneous reduction should be attempted before open reduction. Internal fixation should be performed using an oblique extraarticular Kirshner wire for all unstable fractures. Grading outcome based on range of motion and the presence or absence of pain is recommended. It is hoped that once the controversies surrounding these fractures are resolved, the long term results of these troublesome injuries will improve.

Displaced fractures of the radial neck in children: long-term results and prognosis of conservative treatment.

Fractures of the radial head or neck in children may lead to radial head deformity and loss of pronation and supination. Trauma may not only be caused by the injury itself, but also may occur secondarily to surgical reduction and manipulation of fracture fragments. Thirty-eight children with displaced radial neck fractures were investigated 2 to 20 years after the initial accident. Whereas radial head deformity was present in 83% of cases, functional disorder was found in only four children (11%). These children had either developed secondary growth disturbances, which had led to a radioulnar synostosis in one case, or they had been treated by open surgical reduction. On follow-up radiographs, all conservatively treated fractures with angulation up to 50 degrees had corrected themselves spontaneously. The high complication rate after open reduction and the poor functional results and inconvenience for the pediatric patient makes conservative treatment of radial neck fractures in children preferable.

Jeffery type 2 injuries of the radial neck in children

In 1950, Jeffery’ classified 24 fractures of the radial neck in children into two groups. Group 1 consisted of 22 cases with lateral tilting of the radial head as a result of valgus stress. In the other two cases, classed as group 2, the radial head had rotated backwards and proximally through 90 degrees into the posterior part of the elbow joint. Because one of the two children also sustained an ipsilateral scaphoid fracture, Jeffery postulated that they first fell on the hand, sustaining a temporary backward dislocation or subluxation of the elbow joint. Then, as the elbow struck the ground, the resultant upward force on the flexed elbow fractured the radial neck by impact against the inferior aspect of the capitellum. Next followed spontaneous reduction of the dislocation, which separated off the radial head rotating it backwards and upwards to lie beneath the capitellum. Only seven more cases of the Jeffery type 2 injury have been reported since2”. In discussing the pathomechanics of two further cases, we show that posterior dislocation does occur first and that there are two stages in this type of injury. Medicolegal implications and suggestion for future management are presented.

Dislocation of the elbow joint associated with fracture of the radial neck in children

We describe two cases of fracture of the radial neck associated with posterolateral dislocation of the elbow. The purpose of this report is to describe the relatively good functional result that can be achieved by a successful closed reduction of this severe injury.

Fractures of the Olecranon and Radial Neck in Children

Over one half of radial neck fractures are associated with other injuries about the elbow. Most radial neck fractures can be treated with closed reduction or with percutaneous probing, even if the other associated injuries require open reduction. The results are good, although radiologic imperfections may be seen after healing. In the older child, olecranon fractures that have significant displacement usually require open reduction with internal fixation.

Leverage Method in Displaced Fractures of the Radial Neck in Children

Displaced radial neck fractures in children usually are treated by open reduction, which introduces additional trauma. Furthermore, the results are not always excellent. In two series of radial neck fractures in children (Types II and III of O'Brien classification), ten were treated surgically (Group I) and 12 were treated by percutaneous leverage method with a Kirschner wire immediately removed after the reduction (Group II). The overall results in Group 2 were better than in Group I. Surgical reduction should be reserved for failed reductions by percutaneous leverage method.

Unusual Monteggia lesions in children

Two cases of fracture of the ulna with fracture-separation of the radial neck in children are presented. In one case there was no displacement of the radial epiphysis and in the other it was subluxated. The mechanism of injury is essentially a valgus strain on the extended elbow caused by a fall onto the out-stretched hand. Reduction of this fracture is difficult to attain by closed manipulation and may displace an undisplaced radial head. Open reduction is advisable and, as the lesion is unstable, some form of fixation may be required; check radiographs of good quality are essential during the first 3 weeks. If reduction cannot be achieved and mal-union or cross-union is expected, it is preferable to put the hand in a neutral or a pronated position as it will be more useful than a hand fixed in supination.

Fracture of the Radial Neck in Children:A Long-Term Follow-up Study of 43 Cases

A series of 43 radial neck or head fractures in children was analysed with respect to the type of fracture and whether conservative or surgical treatment had been employed. Thirty-seven patients were examined after a follow-up period of 1-18 years (average 8 years). Tilting of the radial head, the length of the radius and the size of the radial head were measured roentgenologically to evaluate any growth disturbances. The results were good in 24, fair in 10 and poor in 3 cases. In the 14 patients treated surgically results were good in five, fair in six and poor in three cases. All but two of these patients had an angulation of the radial head of 30 degrees or more. The result was good in 20 of the 23 patients who were treated conservatively because the angulation was less than 30 degrees after reduction. In fair and poor cases the function was impaired by the limitation of motion. Disturbances in growth were generally slight, but an enlargement of the radial head was observed in 16 cases at the follow-up.

Management of fracture dislocation of the radial neck in children

Management of fracture dislocation of the radial neck in children