Neck Osteotomy for Malunion of Neglected Radial Neck Fractures in Children

Ceroni, Dimitri; Campos, Jose Santiago; Dahl-Farhoumand, Agnes; Holveck, Jérôme; Kaelin, André

doi:10.1097/bpo.0b013e3181ec95e0

Cited by 14 publications

(28 citation statements)

References 19 publications

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“…The most common mechanism of injury for Monteggia variant fractures is from fall on an outstretched supinated arm [ 3 , 25 ]. Valgus torque is exerted on the elbow joint which, when combined with the force that is transmitted from the wrist up through the radial shaft, drives the radial head into the capitellum [ 2 , 5 , 20 ]. Because the radius and ulna articulate proximally in only one place, the PRUJ, injury to the radius will transmit the force to the ulna through the PRUJ.…”

Section: Discussionmentioning

confidence: 99%

Posttraumatic Proximal Radioulnar Synostosis after Closed Reduction for a Radial Neck and Olecranon Fracture

Keller

Cole

Stutz

et al. 2018

Case Reports in Orthopedics

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Posttraumatic proximal radioulnar synostosis (PPRUS) is a severe complication of radial head and neck fractures known to occur after severe injury or operative fixation. Cases of PPRUS occurring after minimally displaced, nonoperatively treated radial neck injuries are, by contrast, extremely rare. Here, we present a pediatric case of PPRUS that developed after a nonoperatively treated minimally displaced radial neck fracture with concomitant olecranon fracture. While more cases are needed to establish the association between this pattern of injury and PPRUS, we recommend that when encountering patients with a minimally displaced radial neck fracture and a concomitant elbow injury, the rare possibility of developing proximal radioulnar synostosis should be considered.

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Section: Discussionmentioning

confidence: 99%

Posttraumatic Proximal Radioulnar Synostosis after Closed Reduction for a Radial Neck and Olecranon Fracture

Keller

Cole

Stutz

et al. 2018

Case Reports in Orthopedics

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“…In case of unstable or incomplete close reduction, percutaneous pinning following Metaizeau technique should be performed before open reduction [ 1 , 2 , 5 ]. As salvage procedure, neck osteotomy had been described in children in pain with neglected radial neck fracture [ 6 ]. In this case, if an open reduction had been performed after the second displacement in childhood, surgical management might have been avoided at the age of 33.…”

Section: Discussionmentioning

confidence: 99%

Radial Neck Osteotomy for Malunion of Radial Neck Fracture in Childhood

Vandergugten

Troussel

Lefebvre

2015

Case Reports in Orthopedics

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In a case of a neglected radial neck fracture in childhood, the management of initial fracture and its complications are subjected to discussion. In children, open reduction should be avoided but an angulation less than 30° must be obtained. Several techniques exist to manage symptomatic malunion in adults, including resection, prosthesis, and osteotomy. When performing an osteotomy, it is important first to preserve an intact osseous hinge to avoid avascular necrosis and second to align the edge of the radial head articular surface with the lateral edge of the coronoid process, in order to avoid overstuffing elbow joint.

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“…Corrective osteotomies are established procedures for treating long bone deformities 16,17 . For symptomatic radial neck malunions, they have only recently been proposed in small case series 26,27 . Vandergugten et al treated a 33-year old woman with a closing wedge osteotomy of a malunited radial neck fracture that the patient sustained at the age of eleven.…”

Section: A C C E P T E Dmentioning

confidence: 99%

“…Fixation was reached with three intraosseous headless screws. Ceroni et al 26 performed a closing wedge osteotomy and intramedullary nail fixation in two children with severe malunion of the radial neck. In both cases, adequate congruency of the radioulnar and radicapitellar joint could be achieved on plain radiographs.…”

Section: A C C E P T E Dmentioning

confidence: 99%

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Computer-Assisted Corrective Osteotomy of Malunited Pediatric Radial Neck Fractures—Three-Dimensional Postoperative Accuracy and Clinical Outcome

Weigelt

Fürnstahl

Schweizer

2017

Journal of Orthopaedic Trauma

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Neglected or incorrect treatment of pediatric radial neck fractures may lead to symptomatic malunions. Computer-assisted corrective osteotomies with patient-specific guides have been proposed as a promising technique for the reconstruction of malunited long bone deformities. The aim of this study was to evaluate the accuracy and clinical outcome of this technique in children with malunited fractures of the radial neck. Four children [2 boys, 2 girls; mean age 12 (10-16) years] underwent computer-assisted closing wedge osteotomy of the radial neck. The contralateral uninjured side was used as a reconstruction template. Computed tomography were performed 8 weeks postoperatively to confirm bony consolidation and to quantify residual 3D rotational and translational displacement error. Clinical outcome [pain, range of motion (ROM)] and overall satisfaction were documented. Preoperative subluxation of the radial head could be corrected in 2 of 3 patients. One patient had to be revised because of secondary traumatic loss of reduction. At the last follow-up [mean 16 (range, 12-24) months], all patients were pain free for activities of daily living (preoperative pain: visual analog scale 6). Pain during sport activities could be substantially reduced (visual analog scale 8→2). Although the procedure failed to improve ROM, none of the patients had limitations regarding work, daily, or sports activities. Yet, restricted ROM was considered as a cosmetic problem in 1 patient. Full consolidation of the osteotomy site, with no signs of avascular necrosis of the radial head, was achieved in all patients. The deformity could be substantially reduced, from a 3D angle of 13-40 degrees to 3-7 degrees (58%-89% deformity correction). Computer-assisted corrective osteotomy is a novel technique for the treatment of radial neck malunions that led to adequate pain reduction and 3D accuracy of deformity correction in our small case series. Despite the lack of improved ROM, all patients were satisfied and would undergo the same procedure again.

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Neck Osteotomy for Malunion of Neglected Radial Neck Fractures in Children

Abstract: Case series, level IV evidence.

Cited by 14 publications

References 19 publications

Posttraumatic Proximal Radioulnar Synostosis after Closed Reduction for a Radial Neck and Olecranon Fracture

Posttraumatic Proximal Radioulnar Synostosis after Closed Reduction for a Radial Neck and Olecranon Fracture

Radial Neck Osteotomy for Malunion of Radial Neck Fracture in Childhood

Computer-Assisted Corrective Osteotomy of Malunited Pediatric Radial Neck Fractures—Three-Dimensional Postoperative Accuracy and Clinical Outcome

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