Indirect Reduction and Intramedullary Pinning in Severely Displaced Radial Neck Fractures in Children

Devgan, Ashish; Singh, R. P.; Kumar, Suresh; Verma, Vinit; Magu, Narender Kumar; Siwach, Ramchander

doi:10.4236/ijcm.2011.22014

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…If plate fixation fails to offer reliable axial support, a hybrid technique combining with intramedullary pinning seems useful to compensate for that deficiency. The intramedullary pinning technique is always manipulated in children radial neck fractures, which allows minimally invasive and is easily performed, representing a favorable result with few complications [ 33 ]. Sandmann et al [ 34 ] first report that intramedullary pinning not only suits to radial neck fractures in children but satisfactory in adults.…”

Section: Discussionmentioning

confidence: 99%

A hybrid technique combining intramedullary pinning with extramedullary plate fixation in unstable and comminuted radial head fractures following on-table reconstruction

Gao

Dai

Yin

et al. 2021

BMC Musculoskelet Disord

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Background Management of comminuted radial fractures remains controversial. Currently, the emergence of on-table reconstruction technique has made fixation in comminuted radial head fractures more viable. However, the present study reported an intro-operative unstable displacement from the reconstructed radial head to the neck during plate fixation, characterized by a poor radiocapitellar contact and incongruity between the radial head and neck. A hybrid technique combining with intramedullary pining was performed in our study to restore the normal alignment and maintain the stability of fixation. Therefore, the purpose of this article aimed to prove the feasibility of unstable comminuted radial head fractures treated with the extramedullary plate and intramedullary pinning fixation using titanium elastic nails. Methods The clinical, functional and radiographic outcomes of the groups were compared during follow-up. The radiographic examination was conducted to evaluate the status of bone union, heterotopic ossification and post-traumatic arthritis. The functional assessment was performed to evaluate clinical effects, which included measurements of range of motion (ROM) in the elbow, Visual Analog Scale (VAS) score, Elbow Self-Assessment score (ESAS), Mayo Elbow Performance score (MEPS), and Disabilities of the Arm, Shoulder, and Hand (DASH)Outcome Measure score. Results Thirteen patients with unstable fractures were participated with an average follow-up of (38.6 ± 4.5) months for the experimental group and (32.0 ± 6.3) months for the control group, respectively. The functional outcomes in the experimental group, including MEPS and DASH, were significantly superior to the control group. However, no significant difference was observed in the elbow ROM and VAS score between two groups. In the last follow-up, one patient with post-traumatic arthritis rated as grades 1 and two with heterotopic ossifications were observed in the experimental group. In the control group, degenerative changes were observed in three cases (grade 1 in two cases and grade 2 in one case) and heterotopic ossifications rated as grade I were found in two patients. Conclusion Collectively, intramedullary pinning with extramedullary plate fixation is feasible in unstable comminuted radial head fractures, which can be considered as a remedial surgery for on-table reconstruction technique.

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Section: Discussionmentioning

confidence: 99%

A hybrid technique combining intramedullary pinning with extramedullary plate fixation in unstable and comminuted radial head fractures following on-table reconstruction

Gao

Dai

Yin

et al. 2021

BMC Musculoskelet Disord

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“…There was a higher prevalence of females and the average age was 8.4 years old, which is in accordance with data from literature. 7 - 9 , 17 , 18 There was a higher prevalence of fractures in women, but there is no agreement on the literature regarding the most affected gender. 2 , 3 , 9…”

Section: Discussionmentioning

confidence: 95%

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

et al. 2016

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Objective: To evaluate the results of displaced radial neck fractures in children trated surgically with flexible titanium intramedullary nails. Method: This is a retrospective study of five cases of radial neck fractures with displacement greater than 30° fixed with flexible intramedullary nails. Patients were evaluated regarding functional outcome through range of motion and the Mayo Elbow Performance Score (MEPS), as well as radiographic exams. Results: Five patients, with a mean age of 8.4 years were assessed, during a mean post-operative follow up of 12.2 months. Open reduction was necessary in three cases with major displacement. At the end of the follow up, 80% of the patients had excellent results, 20% good results, and all fractures healed. As complications we observed: heterotopic ossification, superficial infection and radial head necrosis. Conclusions: In spite of the small sample, our results with flexible titanium intramedullary nails were similar to the current literature, with good functional outcomes. Level of Evidence III, Retrospective Study.

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“…OR should only be performed when closed reduction fails. For example, the introduction of an intramedullary device may be challenging if angulation exceeds 80° [ 68 ]. A small incision (<3 cm) is recommended [ 20 ], the annular ligament should be preserved, and instruments that could damage the radial head during reduction should be avoided.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Radial Neck Fractures: A Systematic Review Regarding the Influence of Fracture Treatment on Elbow Function

et al. 2022

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Background: This review aims to identify what angulation may be accepted for the conservative treatment of pediatric radial neck fractures and how the range of motion (ROM) at follow-up is influenced by the type of fracture treatment. Patients and Methods: A PRISMA-guided systematic search was performed for studies that reported on fracture angulation, treatment details, and ROM on a minimum of five children with radial neck fractures that were followed for at least one year. Data on fracture classification, treatment, and ROM were analyzed. Results: In total, 52 studies (2420 children) were included. Sufficient patient data could be extracted from 26 publications (551 children), of which 352 children had at least one year of follow-up. ROM following the closed reduction (CR) of fractures with <30 degrees angulation was impaired in only one case. In fractures angulated over 60 degrees, K-wire fixation (Kw) resulted in a significantly better ROM than intramedullary fixation (CIMP; Kw 9.7% impaired vs. CIMP 32.6% impaired, p = 0.01). In more than 50% of cases that required open reduction (OR), a loss of motion occurred. Conclusions: CR is effective in fractures angulated up to 30 degrees. There may be an advantage of Kw compared to CIMP fixation in fractures angulated over 60 degrees. OR should only be attempted if CR and CRIF have failed.

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Indirect Reduction and Intramedullary Pinning in Severely Displaced Radial Neck Fractures in Children

Cited by 3 publications

References 21 publications

A hybrid technique combining intramedullary pinning with extramedullary plate fixation in unstable and comminuted radial head fractures following on-table reconstruction

A hybrid technique combining intramedullary pinning with extramedullary plate fixation in unstable and comminuted radial head fractures following on-table reconstruction

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

Pediatric Radial Neck Fractures: A Systematic Review Regarding the Influence of Fracture Treatment on Elbow Function

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