Percutaneous reduction and leverage fixation using K-wires in paediatric angulated radial neck fractures

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.

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“…[8] The 3rd method uses a percutaneous K-wire to perform direct reduction and internal fixation. [9] …”

Section: Discussionmentioning

confidence: 99%

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

Jiang

Dang

et al. 2017

Medicine

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“…Moreover, the principle of using K‐wire we manipulated to assist reduction of fracture in radial head is different from pediatric radial neck fracture. For pediatric radial neck fractures, the inserted K‐wire, as a lever, is positioned to touch the site of the fracture site, and then radial neck fracture is reduced. By contrast, a horizontal pressure and downward warping on the K‐wire is given in our study to form a “pushing‐jacking” effect for reduction of radial head fracture.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Treatment of Mason Type II Radial Head Fracture by Intramedullary Pinning

Gao

Yin

Zhou

2019

Orthopaedic Surgery

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ObjectiveTo evaluate the outcome of Mason type II radial head fractures treated by intramedullary pinning.MethodsFrom May 2013 to March 2017, we respectively reviewed 25 patients affected by Mason type II radial head fractures. A total of 12 patients who met criteria for inclusion and exclusion were collected and analyzed. They were all isolated displaced partial articular radial head fractures and treated with intramedullary pinning using titanium elastic nails (TEN). The patients comprised eight men and four women with the mean age of 40 years (range, 21–58 years). The clinical evaluation included the range of motion (ROM) in the elbow, the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH), the visual analogue scale (VAS) for pain rating, and the Mayo Elbow Performance Score (MEPS). Follow‐up radiographs to monitor related complications were evaluated as well.ResultsAll patients were followed‐up with a mean of 21.8 months (range, 12–28 months). The average range of elbow flexion‐extension was barely unaffected in the injured side when compared to the uninjured side (139.08° ± 3.14° vs 140.16° ± 3.01°, P = 0.398) as were pronation of the forearm (86.50° ± 2.75° vs 87.83° ± 2.12°, P = 0.197) and supination of the forearm (87.41° ± 2.53° vs 88.17° ± 1.95°, P = 0.425). The MEPS was 93.75 ± 5.28 points (range, 85–100), the QuickDASH revealed good to excellent results with 2.33 ± 4.56 points (range, 0–14), and the VAS for pain was 0.33 ± 0.78 (range, 0–2). Only two patients had a minor complication with constant affection of the superficial branch of radial nerve.ConclusionIntramedullary pinning technique in the treatment of Mason type II radial head fractures is minimally traumatic and effective and represents good to excellent results in adults.

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“…The reduction manoeuvres are done under fluoroscopic guidance by manipulation through closed reduction or using K wires percutaneously. 16 The fracture should be reduced within 7 days of injury in adults. Later on, fracture reduction will not be possible because of fibrosis and fracture healing.…”

Section: Discussionmentioning

confidence: 99%

Radial neck fracture fixation by Metaizeau technique in adults: A case series and review of literature

Harna

Saini

Lodhi

et al. 2019

Journal of Orthopaedics, Trauma and Rehabilitation

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Purpose: To evaluate the use of Metaizeau technique in the treatment of radial neck fracture in adults. Method: A total of eight patients were treated with intramedullary pinning (Metaizeau technique) using titanium elastic nails. All the patients suffered isolated radial neck fracture. Fracture morphology in all the patients had angulation more than 30° and were displaced, tilted with the impacted articular fragment. All the patients had Mason’s type III or Judet’s type II or III fracture. The mean age of patients was 31.3 years, and all were operated within 7 days of suffering the injury. The mean follow-up was 9 months. For subjective evaluation, patients rated their satisfaction for elbow use on a scale of 1–6. Objective assessment includes Mayo elbow performance score, active range of motion of flexion and extension and forearm rotation. Results: The active ranges of motion and hand grip strength were comparable in both upper limbs. Similarly, the range of flexion–extension and pronation–supination were identical. In all cases, the titanium elastic nails had already been removed after 8 weeks with osseous healing of the radial neck. Patients rated their satisfaction for elbow function as very good in six cases and good in two cases. Conclusions: In the present case series, the results of the use Metaizeau technique in adults were promising. The proper selection of the patient and timing of surgery should be considered judiciously. Further large case series is required to ascertain the results. Level of evidence: Level IV.

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Percutaneous reduction and leverage fixation using K-wires in paediatric angulated radial neck fractures

Abstract: Percutaneous reduction and leverage fixation using K-wires in children with radial neck fractures is a recommended surgical treatment that can achieve recovery of normal radial angulation and elbow motion.

Cited by 45 publications

References 18 publications

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

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

Minimally Invasive Treatment of Mason Type II Radial Head Fracture by Intramedullary Pinning

Radial neck fracture fixation by Metaizeau technique in adults: A case series and review of literature

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