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

Abstract

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.

Comparison of midterm efficacy of Kirschner wires and elastic intramedullary nails after closed reduction of Judet type 3 radial neck fractures in children: a multicenter study

“…However, Falciglia et al ( 22 ) suggested that immobilization is not always necessary if the radial head is stable after surgery, but Langenberg et al ( 23 ) concluded that non-fixed fractures have a higher percentage of loss of range of motion after surgery. If the radius neck fracture Angle is greater than 60°, the use of Kirschner wire fixation after closed reduction may have an advantage over elastic intramedullary nail fixation, but this difference is not significant in fractures angled at 31°–60°.…”

Fractura de cuello y cúpula radial en niños: ¿reducción cerrada o abierta? Reporte de casos clínicos

“…Reducción cerrada: es la primera opción en casos de alto desplazamiento y angulación, se recomienda realizarla bajo sedación y fluoroscopia. En caso de no obtener una reducción adecuada en varios intentos, se recomienda pasar a otro método de tratamiento 7 . Reducción percutánea: se recomienda en casos de alto grado de angulación y desplazamiento, pero con contacto entre la cúpula y la metáfisis.…”

Advances in Pediatric Fracture Diagnosis and Treatment Are Numerous but Great Challenges Remain

“…One frequent cause of a fat pad sign is a radial neck fracture. Langenberg and colleagues [ 19 ] systematically reviewed the literature on pediatric radial neck fractures, particularly on the influence of fracture treatment on range of motion after at least 1 year. In total, 26 studies with a total of 551 children were included.…”