Closed reduction of severely displaced radial neck fractures in children

Abstract

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.

Ultrasonography-Guided Combination with Elbow Arthrography-Assisted Minimally Invasive Treatment of Radial Neck Fractures in Young Children

“…In children of this age, when radial neck fracture occurs, X-ray often presents only a small piece of metaphyseal bone. It is difficult to judge displacement degree and reduction quality during surgery [ 19 , 20 ]. Doctors and patients also need to receive larger X-ray radiation.…”

“…In our work, in comparison with the k -wire group, the surgical-related indicators and elbow function of the Métaizeau group were signally superior. Based on US and arthrography, modified Métaizeau technique visually reduced the impact on children and improved surgical safety in children with radial neck fractures, accelerating the prognostic speed and effect of children [ 20 , 30 ]. In terms of postoperative complications incidence in two groups, the Métaizeau group was also signally superior.…”

Fractures of the proximal radius in children: management and results of 100 consecutive cases

“…Once again, closed reduction is the key point for avoiding possible perfusion deficits and healing delays. In completely dislocated fractures, a percutaneously inserted K-wire can manipulate the radial head using a joy-stick-like technique, thus enabling a closed reduction and subsequent ESIN osteosynthesis [ 23 , 24 ]. Some comparative studies have not shown significant differences in the results after closed and open reduction, and this supports the hypothesis that fracture type and initial degree of dislocation are the most important elements for determining functional outcomes [ 25 ].…”

The Pin: An Orthopaedic Transformation

“…A K-wire may be inserted into the fractured portion of the radial neck, and reduction may be achieved through leverage of the K-wire in conjunction with direct pressure on the radial head with the elbow in flexion or with the Métaizeau technique, which utilizes elastic stable intramedullary nailing (Nancy nailing) for reduction (Figure 11). 45,46 Fracture fixation can then be achieved with either percutaneous pin fixation or with a retrograde elastic nail. 47,48 Distal Radius Distal radius fractures are the most common pediatric fracture seen in the emergency department and comprise nearly one quarter of all pediatric fractures.…”