Better Fixation In Severely Displaced Fracture

Introduction: Fractures of the radial neck are relatively uncommon injuries; the incidence in children is reported to be about 1% of all pediatric fractures and 5% of elbow fractures in children. The radial head may be displaced in any direction, but the most common direction is lateral. Associated injuries may signify a more severe trauma to the elbow. Report: 16 years old boy presented with alleged fall during playing football. Patient slipped during game due to slippery grass. Patient fall with elbow hit the ground. Post trauma complain left elbow swelling, pain and limited range of movement (ROM). X-ray and CT Scan elbow done noted radial neck fracture, completed displacement. Judet classification type IVa. Operation closed manipulative reduction (CMR) and titanium elastic nail system (TENS) performed for this patient. Intraoperatively in view of delayed operation soft callus formed already and make the CMR difficult. Initially we planned to do Metaizeau technique to reduce the fracture but in view of soft callus formation we have to performed Kapanji technique also to release the soft callus formation. Anatomical reduction achieved. Then patient upper limb protected with above elbow backslab for 1 month. [Figure: see text][Figure: see text] Discussions: Treatment of radial neck fracture in adolescenthave to be planned properly. A lot of factor will contribute to final outcome of the injury including age of patient, grade of injury and etc. DE Mattos et al 2016 reported that older patient is more likely to have more severe displacement radial neck fracture requiring open reduction operation. Kaise M et al 2016 reported that the outcome of radial neck fracture appear to be related to severity of displacement rather than surgical manipulation. Metaizeau technique is widely used and recommended. Al-Aubaidi Z et al 2012 say that Metaizeau technique is excellent treatment and patient undergone open reduction had inferior outcome. Conclusion: Radial neck fracture is uncommon injury in children and severity of injury is important indicator for prognosis. Even though older patient and more severe injury can lead to poor outcome. Closed reduction still more favorable than open reduction in managing the fracture

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Radial Neck Fracture: Open Reduction

Pediatric Orthopedic Trauma Case Atlas ◽

10.1007/978-3-319-29980-8_33 ◽

2020 ◽

pp. 225-229

Author(s):

Laura Gill

Keyword(s):

Open Reduction ◽

Radial Neck Fracture ◽

Radial Neck ◽

Neck Fracture

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Radial Neck Osteotomy for Malunion of Radial Neck Fracture in Childhood

Case Reports in Orthopedics ◽

10.1155/2015/871429 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Simon Vandergugten ◽

Serge Troussel ◽

Bernard Lefebvre

Keyword(s):

Avascular Necrosis ◽

Radial Head ◽

Elbow Joint ◽

Open Reduction ◽

Articular Surface ◽

Coronoid Process ◽

Radial Neck Fracture ◽

Radial Neck ◽

Neck Fracture ◽

Initial Fracture

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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Radiological and functional outcomes of modified Metaizeau technique in displaced radial neck fractures

Acta Orthopaedica Belgica ◽

10.52628/87.2.05 ◽

2021 ◽

Vol 87 (2) ◽

pp. 235-241

Author(s):

Ökkeş Bilal ◽

Ali Murat Kalender ◽

Burçin Karslı ◽

Volkan Kılınçoğlu ◽

Mustafa Kınaş ◽

...

Keyword(s):

Closed Reduction ◽

Good Choice ◽

Radial Neck Fracture ◽

Radial Neck ◽

Fractures In Children ◽

Radial Neck Fractures ◽

Neck Fracture ◽

Elbow Function ◽

Poor Outcomes

The management of displaced radial neck fractures in children is still a controversial topic. The objective of this study is to examine the outcomes of modified Metaizeau technique in the children with displaced radius neck fractures. The retrospective study included 15 children with displaced radial neck fracture with an angulation of more than 30° who were managed with the use of leverage technique by mosquito clamps and internal fixation with elastic stable intramedullary nailing (ESIN). Radiological and functional assessments were performed during follow-up. Additionally, the patients were evaluated using Mayo Elbow Per- formance Score (MEPS). All the children could be managed with clamp-assisted closed reduction. The average duration of follow up was 25.5 ± 6.1 months (15-36 months). An excellent elbow function was achieved in all but one patient. Based on Metaizeau classification, excellent, good, fair, and poor outcomes were achieved in 11, 1, 2, and 1 patients, respectively. The average postoperative MEPS score was 98.7 ± 5.1 (80-100). Clamp-assisted closed reduction and fixation with ESIN is a good choice in the children with displaced radial neck fractures. This technique is associated with good functional and radiologic outcomes in the medium-term. Further studies are warranted with larger sample sizes.

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Percutaneous leverage technique for reduction of radial neck fractures in children: technical tips

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.190130 ◽

2020 ◽

Vol 14 (2) ◽

pp. 118-124

Author(s):

Colyn J. Watkins ◽

Caleb M. Yeung ◽

Emily Rademacher ◽

Dennis E. Kramer

Keyword(s):

Case Series ◽

Intramedullary Fixation ◽

Complication Rates ◽

Level Of Evidence ◽

Small Incision ◽

Radial Neck Fracture ◽

Radial Neck ◽

Fractures In Children ◽

Radial Neck Fractures ◽

Neck Fracture

Purpose Paediatric radial neck fractures are challenging to treat. Multiple strategies exist for reduction and fixation; there is no clear consensus on the best surgical technique to achieve reduction. The percutaneous leverage technique is a method for reduction of radial neck fractures that has previously been described by Wallace, though there is a lack of published literature on this technique. We present a technical note and a modest case series on our modification to the percutaneous leverage technique accompanied by intramedullary fixation. Methods We describe a retrospective series of patients who underwent the modified percutaneous leverage technique for paediatric radial neck fracture reduction followed by flexible intramedullary nail fixation at a single Level I trauma centre from 2008 to 2016. This technique involves making a small incision over the dorsal border of the ulna and using a blunt curved surgical forceps to dissect towards the ulnar border of the radius just distal to the radial neck fracture site. The curved forceps is then used to push the radial shaft away from the ulnar shaft which reduces the radial neck fracture. Intramedullary fixation is then utilized to stabilize the reduction. Pre- and postoperative radiographs and clinical data from the medical record were reviewed, and patient, injury and treatment characteristics as well as complication rates are summarized. Results We successfully treated a series of eight radial neck fractures with the modified percutaneous leverage technique. This technique allows for a small incision and a minimally invasive method for the reduction of paediatric radial neck fractures. This allowed for subsequent intramedullary fixation and early postoperative elbow mobilization. In our series, no patients developed synostoses or sustained peripheral nerve injuries using this technique. Conclusion The modified percutaneous leverage technique followed by intramedullary fixation is a safe and effective technique for fixation of displaced paediatric radial neck fractures. Level of Evidence Level IV

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Radial Neck Fracture: Open Reduction

Pediatric Orthopedic Trauma Case Atlas ◽

10.1007/978-3-319-28226-8_33-1 ◽

2018 ◽

pp. 1-5

Author(s):

Laura Gill

Keyword(s):

Open Reduction ◽

Radial Neck Fracture ◽

Radial Neck ◽

Neck Fracture

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FUNCTIONAL OUTCOME OF DISPLACED PAEDIATRIC RADIAL NECK FRACTURE TREATED BY OPEN REDUCTION –A CASE REPORT

10.36106/ijar/9304308 ◽

2021 ◽

pp. 36-37

Author(s):

K Anusha ◽

P Archana Babu ◽

K Srinivasa Reddy

Keyword(s):

Radial Head ◽

Open Reduction ◽

Full Range ◽

Vascular Supply ◽

Complete Healing ◽

Radial Neck Fracture ◽

Radial Neck ◽

Epiphyseal Injury ◽

Neck Fracture ◽

K Wires

A pediatric radial neck fracture, is still a challenging problem for the treating orthopedic surgeon. We report a pediatric patient presenting with radial neck fracture and results of open reduction and xation with k wires. A 8-year-old right-handed boy fell on an out-stretched left arm after being tackled during playing kabaddi and had a radial neck fracture. At the rst radiologic examination, the anteroposterior and lateral radiographs were showing over 80 degrees of angulation at the radial neck and subluxation of the radiocapitellar joint. We tried to obtain a closed reduction, but we could not succeed. Then, we performed open reduction while preserving medial periosteal continuity and vascular supply of the radial head by meticulous surgical dissection. Sixth-month radiography control and clinical examination conrmed the complete healing of the fracture without any epiphyseal injury. Painless full range of motion without any restriction of pronation and supination was achieved. The patient and his parents were satised with the outcome. We conclude that, if we can preserve medial periosteal continuity and vascularity of the radial head with open reduction, satisfactory results are obtainable.

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Late Presenting Pediatric Radial Neck Fracture: A Case Report and Review of the Literature

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i01.1948 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kaya Turan ◽

Cenk Köroglu ◽

Haluk Çabuk

Keyword(s):

Case Report ◽

Radial Head ◽

Open Reduction ◽

Full Range ◽

Vascular Supply ◽

Complete Healing ◽

Radial Neck Fracture ◽

Radial Neck ◽

Epiphyseal Injury ◽

Neck Fracture

Introduction: A pediatric radial neck fracture, when the diagnosis is delayed, is still a challenging problem for the treating orthopedic surgeon. We report a pediatric patient with late presenting radial neck fracture and results of open reduction and fixation with Kirschner wires. Case Report: A 13-year-old right-handed girl fell on an out-stretched right arm after being tackled during playing basketball and had a radial neck fracture. However, the diagnosis of her fracture was delayed for 3 weeks. At the first radiologic examination, the anteroposterior and lateral radiographs were showing over 80 degrees of angulation at the radial neck and subluxation of the radiocapitellar joint. We tried to obtain a closed reduction, but we could not succeed. Then, we performed open reduction while preserving medial periosteal continuity and vascular supply of the radial head by meticulous surgical dissection. Sixth-month radiography control and clinical examination confirmed the complete healing of the fracture without any epiphyseal injury. Painless full range of motion without any restriction of pronation and supination was achieved. The patient and her parents were satisfied with the outcome. Conclusions: Even if the diagnosis of pediatric radial fractures is delayed if we can preserve medial periosteal continuity and vascularity of the radial head with open reduction, satisfactory results are obtainable. Keywords: Pediatric, radial neck fracture, open reduction, late diagnosis.

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Outcome of open reduction and Kirschner wire fixation in pediatric radial neck fracture

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00402 ◽

2021 ◽

Vol 24 (4) ◽

pp. 239-244

Author(s):

Alireza Rouhani ◽

Mohammadreza Chavoshi ◽

Alireza Sadeghpour ◽

Hossein Aslani ◽

Mohsen Mardani-Kivi

Keyword(s):

Range Of Motion ◽

Closed Reduction ◽

Open Reduction ◽

Kirschner Wire ◽

Primary Treatment ◽

Radial Neck Fracture ◽

Radiographic Outcomes ◽

Radial Neck ◽

Kirschner Wire Fixation ◽

Neck Fracture

Background: Radial neck fracture in children is rare. This study attempted to evaluate the outcome of surgically treated patients and any associated complications.Methods: This study evaluated 23 children under 15 years of age with radial neck fracture who were treated with open reduction between 2006 and 2016 to determine their range of motion, postoperative complications, and radiographic outcomes. The results were assessed clinically using the Mayo clinic elbow performance score. Results: The mean follow-up duration for patients was 34.6 months. The average postoperative angulation was 3.6º. Hypoesthesia was reported in only 9% of patients, and none of the patients complained of postoperative pain. The postoperative X-ray results were excellent in 60% and good in 40%. No radiographic complications were identified. The Elbow score was excellent in 87% and good in 13% (mean score, 96.74). There was a statistical relationship between range of motion limitations and age, degree of fracture, initial displacement, and surgical pin removal time.Conclusions: Although most patients accept the closed reduction method as a primary treatment, the present study suggests that an open-reduction approach has been associated with optimal therapeutic outcomes for patients in whom closed reduction was not satisfactory or indicated.

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