Closed reduction using the percutaneous leverage technique and internal fixation with K-wires to treat angulated radial neck fractures in children-case report

Abstract

Pediatric radial neck fractures are uncommon. Severely displaced and angulated fractures usually require treatment. Our goals for treatment are to avoid incision, reduce the fracture adequately with no reduction loss, and achieve good postoperative function. We aimed to observe the clinical outcomes of closed reduction with the percutaneous leverage technique and internal fixation with Kirschner-wires (K-wires) to treat angulated radial neck fractures in children.From January 2011 to April 2013, we treated 16 cases of angulated radial neck fracture in 12 boys and 4 girls. Five fractures were type II and 11 fractures were type III using the O’Brien classification. One K-wire was percutaneously introduced into the fracture site using the leverage technique to attain good reduction. Two K-wires were introduced from the proximal to the distal areas of the fracture site. The elbow was immobilized by cast in 90° of flexion and the forearm in supination for 3 to 4 weeks. The K-wires were removed at 3 to 4 weeks postoperatively. All cases were followed up for a mean duration of 3 years 6 months.According to the Metaizeau reduction classification, 12 cases were excellent, and 4 cases were good. According to the Metaizeau clinical classification, 14 cases were excellent, and 2 cases were good. There was no necrosis of the radial head. There was no infection, radioulnar synostosis, and damage of the radial nerve deep branch. There was no limitation in the pronation and supination functions of the forearm.Closed reduction using the percutaneous leverage technique and internal fixation using K-wires is easy to perform. It is encouraged to use this approach as the clinical outcome is good.Level of evidence: level IV-retrospective case, treatment study.

Closed reduction of severely angulated Rockwood and Wilkins’ type C thumb Metacarpal Base fractures in children: case series

“…The number of leverage-based manual reduction attempts can be reduced to fewer than 3, while injury to the physis caused by the tip of the leverage K-wire can be avoided. In general, manual reduction and leverage treatment for paediatric fractures, including S-H type II fractures of the distal radius, radial neck fractures, supracondylar fractures, and Bennett fractures, are successful and yield good results [ 18 – 21 ]. We first conducted leverage reduction to anatomically reduce the fractures in our study.…”

Closed Reduction of Severely Angulated Rockwood and Wilkins’ Type C Thumb Metacarpal Base Fractures in Children

“…In general, manual reduction and leverage treatment for paediatric fractures, including S-H type II fractures of the distal radius, radial neck fractures, supracondylar fractures, and Bennett fractures, are successful and yield good results, and satisfactory results have been reported [18][19][20][21]. We performed leverage reduction to anatomically reduce these fractures.…”

Closed Reduction of Severely Angulation Rockwood and Wilkins’ Type C Thumb Metacarpal Base Fractures in Children

“…Jehanno et al reported open reduction is not due to interposition of tendons or of the periosteum [7]. In general, manual reduction and leverage treatment of pediatric fractures are successful in most cases with good results, including S-H type fractures of the distal radius, radial neck fracture, supracondylar fracture, Bennett fracture, and satisfactory results have been achieved [14][15][16][17]. We conduct leverage reduction to obtain anatomical reduction of these fractures.…”