Evaluation of Children With Radial Neck Fractures Treated With Flexible Intramedullary Nail

Gagliardi, Isabella da Costa; Mouraria, Guilherme Grisi; Funayama, Bruno Schiavoni; Kikuta, Fernando Kenji; Cruz, Márcio Alves; Filho, Américo Zoppi

doi:10.1590/1413-785220162402154788

Cited by 9 publications

(6 citation statements)

References 15 publications

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“…It is reported that either the acceptable value of radial neck angle after the operation should be under 20° that the reduction was adequate. 2 , 5 , 7 , 21 Any residual tilt more than 20° was related with the poor outcomes, which could affect functional results adversely. In our study, all reductions were anatomically which was supported by excellent results.…”

Section: Discussionmentioning

confidence: 99%

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Intramedullary elastic nailing of the displaced radial neck fractures in children

Koca¹,

Erdem²,

Neyisci³

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to report the clinical and radiological results of 11 patients with Judet type 3 severely displaced radial neck fractures, who were treated with intramedullary elastic nail fixation with the help of percutaneous K-wire reduction maneuver (Métaizeau technique).MethodsA total of 11 children (4 boys and 7 girls with a mean age of 7.7 (6–10) years) with Judet type 3 radial neck fractures were treated in our clinic between February 2013 and August 2015. The fractures were evaluated according to Judet classification system modified by Métaizeau. Reduction and fixation was performed within the first 24 h after injury in all patients. All fractures were treated by closed reduction using distal elastic intramedullary nail. Clinical evaluation was performed by measuring elbow range of motion (ROM) with goniometer, radiological evaluation by assessing fracture healing and functional evaluation by using Mayo Elbow Performance Score (MEPS).ResultsThe mean MEPS score increased from 15 points preoperatively to 88 points postoperatively (range, 12–95 points). Radiological evaluation revealed that all fractures healed with excellent or good alignment. The mean flexion was 150° (range, 145–154°), extension 1° (range, 0–2°), supination 82° (range, 80–86°), and pronation 83° (range, 80–85°).ConclusionReduction and osteosynthesis of radial neck fractures by intramedullary nailing with the help of percutaneous K-wire manipulation appears to be a simple, safe and effective treatment method in children.Level of evidenceLevel IV, Therapeutic study.

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Section: Discussionmentioning

confidence: 99%

“…Displaced radial head and neck fractures are rare injuries in children, with an incidence of 1–5% of all pediatric elbow fractures. 1 The highest prevalence is between 9 and 12 ages, 2 and fall on the outstretched arm with the elbow extended, which causes valgus compression over the radial head, is defined as the injury mechanism.…”

Section: Introductionmentioning

confidence: 99%

Intramedullary elastic nailing of the displaced radial neck fractures in children

Koca¹,

Erdem²,

Neyisci³

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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“…Iconographic assessment was performed by evaluating postoperative X-rays according to Métaizeau criteria 10 , whereby anatomic reduction was classified as excellent, inclination < 20° was good, inclination of 20°–40° was average, and inclination >40° was poor. Assessment of elbow function was according to the MEPS 6 , whereby pain was 45, function was 25, radius was 20, and elbow stability was 10, out of a total score of 100. A score of 95–100 was considered excellent, 80–94 was good, 60–79 was average, and 0–59 was poor.…”

Section: Methodsmentioning

confidence: 99%

“…Radial neck fracture is common in children, accounting for approximately 1%–2.7% of all children’s fractures and 5%–10% of elbow fractures. 1–5 Severely displaced Judet IV radial neck fractures are not easy to treat using minimally invasive methods such as the Métaizeau technique and single Kirschner (k)-wire percutaneous leverage reduction, 2,4–7 while open reduction may aggravate the elbow injury, increase the risk of radial necrosis and non-union, and decrease treatment effectiveness. 3,8,9 Furthermore, some researchers have suggested that open reduction does not influence the overall treatment effectiveness of radial neck fracture.…”

mentioning

confidence: 99%

Percutaneous leverage reduction with two Kirschner wires combined with the Métaizeau technique versus open reduction plus internal fixation with a single Kirschner-wire for treating Judet IV radial neck fractures in children

Xiong

et al. 2019

J Int Med Res

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ObjectiveTo compare the clinical effectiveness of a novel approach, percutaneous leverage reduction using two Kirschner-wires (k-wires) combined with the Métaizeau technique, versus open reduction plus internal fixation with k-wire for the treatment of Judet IV radial neck fractures in children.MethodsThirty-four patients with Judet IV radial neck fractures were treated either with percutaneous leverage reduction using two k-wires and the Métaizeau technique (n = 16) or open reduction plus internal fixation with k-wire (n = 18). Patient data including sex, age, time from trauma to surgery, fracture type, follow up, postoperative healing time, X-ray studies, elbow function, and complications were collected.ResultsThere were no significant differences in patient characteristics between the two treatment groups. In postoperative elbow function assessment, 93.8% of patients in the group that underwent the novel treatment approach had a score of excellent or good, compared with 83.3% of patients in the open reduction and internal fixation with k-wire group. Furthermore, no postoperative complications were reported in patients in the novel treatment group, compared with 5 patients in the open reduction and internal fixation with k-wire group. All patients in both groups were classified as excellent or good according to Métaizeau criteria in postoperative X-ray assessment.ConclusionsCompared with the open reduction and internal fixation with k-wire approach, percutaneous leverage reduction using two k-wires combined with the Métaizeau technique can significantly increase the minimally invasive reduction rate, and represents an attractive strategy for the treatment of Judet IV radial neck fractures in children.

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“…Der Unfallmechanismus ist hierbei ein Sturz auf den pronierten oder supinierten ausgestreckten Arm. Durch die daraus resultierende axiale Kraft zwischen dem Capitulum humeri und dem Radiusköpfchen kommt es zu einer Fraktur des proximalen Radius [3,4].…”

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Operative Versorgungsstrategien und deren radiologisches Korrekturpotenzial bei proximalen Radiusfrakturen des Kindes und Jugendlichen

et al. 2021

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QR-Code scannen & Beitrag online lesen Zusammenfassung Hintergrund und Fragestellung: Die isolierte proximale Radiusfraktur bei Kindern ist eine seltene Verletzung. Anders als im Erwachsenenalter kann die Fraktur bei Kindern oft konservativ behandelt werden. Bei entsprechender Dislokation ist jedoch die Indikation zur operativen Behandlung großzügiger zu stellen. In diesem Fall stehen verschiedene Therapieoptionen zur Verfügung. Ziel dieser Arbeit ist es, die einzelnen Versorgungsmöglichkeiten gegenüberzustellen und deren Qualität zu beurteilen. Studiendesign und Untersuchungsmethoden: Es handelt sich um eine retrospektive Untersuchung. Eingeschlossen wurden 82 Patienten, die zum Operationszeitpunkt 18 Jahre oder jünger waren und aufgrund einer proximalen Radiusfraktur operativ versorgt wurden. Anschließend wurden die Frakturen nach der pädiatrischen Klassifikation der Arbeitsgemeinschaft für Osteosynthesefragen (AO) eingeteilt. Der prä-und postoperative "Abkippungswinkel" im anterioren/posterioren und im seitlichen Röntgenbild wurden miteinander verglichen und galten als Maß zur Beurteilung der Versorgungsqualität. Ergebnisse: Die geringste postoperative Abkippung zeigte sich nach Stabilisierung mittels Kirschnerdraht mit einem Winkel von 15,8°, die Implantation von HCS-Schraube ("Headless Compression screw") zeigte eine Abkippung von 16°. Die geschlossene Reposition zeigte einen Winkel von 19°, mit Implantation eines TEN (titan elastic nail) von 20°und die alleinige offene Reposition einen Winkel von 21°. Es zeigte sich kein erkennbarer Zusammenhang zwischen dem Schwierigkeitsgrad der Fraktur (I-III nach der AO-Klassifikation) und dem postoperativen Ergebnis. Schlussfolgerung: Die Studie zeigt, dass das postoperative Ergebnis nicht durch die vorausgegangene AO-Klassifikation, sondern vielmehr von der Wahl des richtigen Operationsverfahrens beeinflusst wird. Trotz der guten radiologischen Ergebnisse der offenen Reposition mit gleichzeitiger Stabilisierung sollten diese Verfahren nur zum Einsatz kommen, wenn weniger invasive Maßnahmen nicht verwendet werden können, um das Risiko von aseptischen Nekrosen so gering wie möglich zu halten.

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Evaluation of Children With Radial Neck Fractures Treated With Flexible Intramedullary Nail

Cited by 9 publications

References 15 publications

Intramedullary elastic nailing of the displaced radial neck fractures in children

Intramedullary elastic nailing of the displaced radial neck fractures in children

Percutaneous leverage reduction with two Kirschner wires combined with the Métaizeau technique versus open reduction plus internal fixation with a single Kirschner-wire for treating Judet IV radial neck fractures in children

Operative Versorgungsstrategien und deren radiologisches Korrekturpotenzial bei proximalen Radiusfrakturen des Kindes und Jugendlichen

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