Pediatric displaced radial neck fractures: retrospective results of a modified Metaizeau technique

Abstract

Treatment of displaced radial neck fractures is challenging and controversial, as the risk of unsatisfactory outcome increases after operative as well non-operative treatment. Between 2004 and 2012, we treated 14 children with type IV fracture of radial neck with mean angulation of 72.8°, using the modified Metaizeau technique. The average follow-up was 39 months. Heterotrophic ossification and transient posterior interosseous nerve palsy were the only complication seen in two patients who had to undergo open reduction. We feel that the inability to achieve closed reduction can be attributed to loss of periosteal hinge. We obtained 100 % excellent clinical outcome and 79 % excellent radiological outcome at final follow-up. The modified closed intramedullary pin reduction technique proved to be minimal invasive technique for displaced radial neck fractures by allowing stable anatomic reconstruction while avoiding all the complications of classical Metaizeau technique.

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

“…In 1980, Métaizeau 16 was the first to report the use of a closed reduction of the intramedullary nail to treat the radial fracture in children, with good postoperative efficacy. For radial fracture with severe displacement and angulation, however, it can be difficult to achieve reduction using the Métaizeau technique alone, 5,7,10 and the use of open reduction has therefore been advocated in these cases. 17…”

“…In 1980, Me´taizeau 16 was the first to report the use of a closed reduction of the intramedullary nail to treat the radial fracture in children, with good postoperative efficacy. For radial fracture with severe displacement and angulation, however, it can be difficult to achieve reduction using the Me´taizeau technique alone, 5,7,10 and the use of open reduction has therefore been advocated in these cases. 17 Recently, some researchers have used a Kirschner needle to supplement the Me´taizeau method in the treatment of children with radial neck fractures, although this approach is primarily used in Judet type III cases.19 Judet IV fractures are frequently difficult to reset, resulting in a prolonged duration of surgery.…”

“…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.…”

Closed reduction of severely displaced radial neck fractures in children

“…However, few of those authors analyzed why the closed reduction failed and how closed reduction can be achieved for the failed cases. Nitin Bither et al recommended the presence of a periosteal hinge as an obvious marker of success in closed reduction [24]. When we reviewed the unsuccessful procedures, we hypothesized that the integrity of the lateral periosteal hinge and elbow capsule is the anatomic basis of a successful closed reduction, especially in O’Brien type III and Judet type IVb fractures with angulation = 90°and severe edema for which the initial percutaneous leverage failed.…”

Functional and radiological results of percutaneous K-wire aided Métaizeau technique in the treatment of displaced radial neck fractures in children

“…Since closed reduction and intramedullary fixation was first suggested by Métaizeau 14 in 1980, it has been frequently and safely used in the treatment of pediatric radial neck fractures 6 , 9 , 13 , 21 , 22 , 23 , 24 , 25 In order to obtain adequate reduction, sometimes a percutaneous, minimal invasive, extra-articular K-wire can be used. 21 , 22 , 23 , 24 , 25 , 26 Many studies have reported adequate and satisfactory results obtained using this technique. In a study by Okçu G and Aktuğlu K 22 the carrying angle was found to be equal to that of the opposite extremity in 9 patients with an angulation of >30° who were surgically treated with the percutaneous K-wire aided Métaizeau technique.…”