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.

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

Management strategies of pediatric ipsilateral olecranon with associated radial neck fractures based on multicenter experience

Background The ipsilateral olecranon with associated radial neck fractures does not include in the Bado classification of Monteggia fractures and equivalent lesions. The primary aims of this retrospective multicenter study were to characterize this type of injury and, noting its unique properties, evaluate the results of the treatment, determine the prognostic factors that influence the radiological and clinical outcome, and also give treatment strategies. Methods Between July 2011 and July 2016, forearm fracture patient charts were retrospectively reviewed from seven pediatric trauma centers. Patients diagnosed with ipsilateral olecranon with associated radial neck fractures and followed up for at least 24 months were included. Fracture characteristics, treatment, outcome, and complications were assessed. The clinical outcome of treatments was evaluated by the Mayo Elbow Performance Score (MEPS) and the Flynn criteria. Fisher’s exact test and ANOVA test were used; significance was defined as P < 0.05. Results One hundred thirty-seven consecutive patients (54 girls and 83 boys) from 8292 forearm fractures patients, the mean age of 7.5 years (1.5 to 14.8), with fractures of the ipsilateral olecranon with associated radial neck fractures were identified. One hundred twenty-five patients had radiologic and clinical follow-up. According to a simplified classification system with “operate” and “don’t operate” groups, including five subtypes proposed in this study, ipsilateral olecranon with associated radial neck fractures subtypes could be classified with significantly different characteristics and outcome in treatment and complications. Conclusions Fractures of the ipsilateral olecranon associated with the radial neck are not so rare as previously reported. Complications and poor outcomes were easy to encounter without knowing this type of fracture. Appropriate treatment strategies could be made according to a simple classification system based on the treatment result of follow-up. Level of evidence Retrospective comparative study; Level III