Radial Neck Osteotomy for Malunion of Radial Neck Fracture in Childhood

Vandergugten, Simon; Troussel, Serge; Lefebvre, Bernard

doi:10.1155/2015/871429

Cited by 3 publications

(10 citation statements)

References 17 publications

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“…30 One major concern with corrective osteotomy of the proximal radius is the risk of avascular necrosis. 7,12,19 The radial epiphysis is cartilaginous, intra-articular, and devoid of soft-tissue attachments, all of which may contribute to the risk of osteonecrosis after acute trauma or surgical reconstruction. In a minority of cases, vascularity to the growing chondroepiphysis may be compromised, leading to AVN.…”

Section: Discussionmentioning

confidence: 99%

Corrective Osteotomy for Symptomatic Radial Head and Neck Malunions in the Skeletally Immature

Bhashyam

Hadley

Beatty

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Radial head and neck fracture malunion can lead to pain, stiffness, deformity, and functional limitations. This study analyzed the early radiographic and functional outcomes of corrective osteotomy for symptomatic radial head and/or neck malunion in skeletally immature patients. Methods: Thirteen pediatric patients treated with corrective osteotomy for symptomatic radial head and/or neck malunion from 2004 to 2018 were identified. Radiographic union, range of motion, pain, and complications were recorded. Functional outcomes were assessed using the Broberg and Morrey Elbow Scale. Results: The average age at the time of surgery was 12.3 years (range: 8.6 to 16.3). The mean time from injury to osteotomy was 7.5 months (range: 2 to 24.1 mo). Before osteotomy, mean radial head-shaft angulation was 23 degrees (range: 5 to 57 degrees), mean displacement was 76% (range: 0 to 55), average elbow flexion contracture was 18 degrees (range: 0 to 60 degrees), and average elbow flexion was 112 degrees (range: 95 to 135 degrees). After a mean follow-up of 14.3 months, 12 of 13 osteotomies (92%) healed; 1 patient had a painless nonunion. The number of patients reporting pain decreased from 9 to 2 (P=0.012). Radiographic alignment and range of motion improved in all patients. Mean angulation and displacement improved to 8 degrees (range: 2 to 15 degrees, P=0.001) and 3% (range: 0 to 18 degrees, P=0.001), respectively. Mean elbow flexion contracture was reduced to 5 degrees (range: 0 to 30 degrees, P=0.008), and the average elbow flexion increased to 128 degrees (range: 100 to 135 degrees, P<0.001). Three patients underwent implant removal for complications, including heterotopic ossification and avascular necrosis. Physeal arrest did not lead to any adverse sequelae. The sole case of avascular necrosis had a reduced range of motion but no pain. The mean postoperative Broberg and Morrey score was 91.1; 7 patients had excellent postoperative scores, 4 good, and 2 fair. Conclusions: Corrective osteotomy for symptomatic malunion of the radial head and/or neck in skeletally immature patients can improve elbow alignment, motion, pain, and function. Preservation of the soft-tissue attachments to the proximal epiphysis and rigid internal fixation are critical components of this surgical technique. Level of Evidence: Therapeutic Level IV.

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Section: Discussionmentioning

confidence: 99%

Corrective Osteotomy for Symptomatic Radial Head and Neck Malunions in the Skeletally Immature

Bhashyam

Hadley

Beatty

et al. 2023

Journal of Pediatric Orthopaedics

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“…The reported incidence of mal-union is equally low, ranging from 0% to 4%[ 3 , 27 , 28 ]. Patients may present with elbow pain and restricted motion, which can occur up to decades after the initial injury in rare cases[ 53 , 54 ]. The diagnosis is made using conventional radiographs.…”

Section: Complicationsmentioning

confidence: 99%

“…Limited data are available on the results of surgical interventions in these patients. Case series have shown overall pain reduction after osteotomy, but contrasting results with regards to restoring range of motion[ 53 , 54 , 56 ]. Mal-union of the proximal radius should be distinguished from partial growth arrest or injury of the growth plate of the radius, resulting in a posttraumatic malformation of the radial head, most commonly an enlargement of the radial head and an incongruent proximal radioulnar joint[ 8 , 26 ].…”

Section: Complicationsmentioning

confidence: 99%

Diagnosis, treatment and complications of radial head and neck fractures in the pediatric patient

Macken

Eygendaal

Bergen

2022

WJO

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Radial head and neck fractures represent up to 14% of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient. In up to 39% of proximal radius fractures, there is a concomitant fracture, which can easily be overlooked on the initial standard radiographs. The treatment options for proximal radius fractures in children range from non-surgical treatment, such as immobilization alone and closed reduction followed by immobilization, to more invasive options, including closed reduction with percutaneous pinning and open reduction with internal fixation. The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient; an angulation of less than 30 degrees and translation of less than 50% is generally accepted, whereas a higher degree of displacement is considered an indication for surgical intervention. Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures, range of motion and complications compared to severely displaced fractures requiring surgical intervention. With proper management, good to excellent results are achieved in most cases, and long-term sequelae are rare. However, severe complications do occur, including radio-ulnar synostosis, osteonecrosis, rotational impairment, and premature physeal closure with a malformation of the radial head as a result, especially after more invasive procedures. Adequate follow-up is therefore warranted.

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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%

“…On the other hand, the treatment of radial neck malunions is scarcely discussed in literature and only case reports have been published [26][27][28] . Despite the lack of improved pro-and Demographical data as well as pre-and postoperative pain scores (noted as visual analogue scale (0-10 points)) are displayed.…”

Section: A C C E P T E Dmentioning

confidence: 99%

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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Radial Neck Osteotomy for Malunion of Radial Neck Fracture in Childhood

Cited by 3 publications

References 17 publications

Corrective Osteotomy for Symptomatic Radial Head and Neck Malunions in the Skeletally Immature

Corrective Osteotomy for Symptomatic Radial Head and Neck Malunions in the Skeletally Immature

Diagnosis, treatment and complications of radial head and neck fractures in the pediatric patient

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

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