Outcome of open reduction and Kirschner wire fixation in pediatric radial 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.

Comparison of different treatments for children with radial neck fracture and analysis of prognostic factors

Introduction The aim of this was to analyze the effect of different treatment options on radial neck fractures in children and to explore the factors affecting the prognosis of fractures. Methods The clinical data of 131 children with radial neck fractures admitted to our hospital from 2010 to 2018 were retrospectively analyzed, and the patients were divided into 6 groups according to treatment methods [manual reduction with Kirschner wires (K-wires) for internal fixation (group A); manual reduction with elastic stable intramedullary nails (ESINs) for internal fixation (group B); leverage reduction with K-wires for internal fixation (group C); leverage reduction with ESINs for internal fixation (group D); manual and leverage reduction with K-wires/ESINs for internal fixation (group E); and open reduction with K-wires/ESINs for internal fixation (group F)]. Postoperative elbow function and complications were analyzed. Results Among the 131 patients with fractures, the median age was 8 years, the median preoperative angulation was 52°, the follow-up rate was 86.3% (113/131), the average follow-up time was 58.3 months, and the postoperative complication rate was 17.7% (20/113). The comparison among the different treatment groups showed that group B had the best recovery of elbow function, postoperatively, and the lowest postoperative complication rate. Age, duration of hospitalization, and preoperative angulation were independent factors affecting postoperative complications. Older age, longer duration of hospitalization, and higher angulation increase the postoperative complications. Conclusion Different treatment options have different efficacies for radial neck fractures in children, of which manipulative reduction with internal fixation using ESINs can achieve good efficacy and a low postoperative complication rate. Age, duration of hospitalization, and preoperative angulation are independent factors for postoperative complications.

Displaced Radial Neck Fractures in the Paediatric Age Group Fixed with the Modified Metaizeau Technique: Experience of a Tertiary Care Hospital in Northern India

Background Radial neck fractures in the pediatric population represent up to one percent of all pediatric fractures. Judet type III and IV radial neck fractures present difficulties in closed and open reduction. The Metaizeau technique has been used as a tool to reduce these. We present a case series of 17 patients with Judet III and IV type of radial neck fractures treated with a modified Metaizeau technique. Materials and Methods Seventeen patients, eight male and nine female with Judet type III and IV radial neck fractures over a two-year period were managed with modified Metaizeau technique as described in the text. The follow up period in our Prospective Interventional study was of six months The outcomes were scored using the Mayo elbow Performance score. Results Fourteen patients had excellent scores, and three had good scores. Union rate was 100%. Fourteen patients were managed with closed reduction using the modified Metaizeau technique. Three patients required additional Open reduction, out of which one had reduced ROM as an outcome at the end of six months. Conclusion The modified Metaizeau technique is an extra articular, easy to learn procedure with good to excellent results in Judet type III and IV radial neck fractures.

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

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.

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

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.

Paediatric Radial Neck Fracture Fixation by Metaizeau Technique - Surgical Technique and Outcome

BACKGROUND Radial neck fractures in children are serious injuries with frequent sequelae when the tilt exceeds 60 degrees. Conservative treatment is often inadequate in such cases and open reduction may produce iatrogenic complications. Displaced radial neck fractures in the paediatric population can be treated with retrograde intramedullary nailing of the radius (the Metaizeau technique). This method allows early post-operative movement and thus has high functional outcome. The purpose of this case series was to evaluate the functional outcome of Metaizeau technique. METHODS This is a prospective study in which follow-up of 9 cases with radial neck fracture treated with Metaizeau technique was done. Clinical and radiological evaluation was done at 2 weeks, 4 weeks, 6 weeks and 6 months. Active range of motion of flexion and extension at elbow and forearm rotation was noted at 6 weeks along with pain score and Mayo Elbow Performance Score (MEPS). Radiological assessment was also done at 6 weeks regarding union. RESULTS 8 out of 9 cases had radiological union at 6 weeks. 1 case was lost to follow-up. Excellent result was obtained in all 8 cases. Range of flexion-extension, supinationpronation were identical in all 8 cases. 1 case developed pressure bursitis at entry site. CONCLUSIONS Metaizeau technique for radial neck fracture fixation is simple, safe, soft tissue sparing, minimally invasive technique giving excellent functional and cosmetic results with minimal complication. KEYWORDS Metaizeau Technique, Retrograde Intramedullary Nailing, Radial Neck Fracture, MEPS