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

Macken, Arno A.; Eygendaal, Denise; Bergen, Christiaan JA van

doi:10.5312/wjo.v13.i3.238

Cited by 12 publications

(15 citation statements)

References 69 publications

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“…Elbow stiffness, radio-ulnar synostosis, avascular necrosis, posterior interosseous nerve injury, heterotopic ossification, nonunion, and malunion are some of the known complications of radial neck fractures with open or closed methods of treatment [ 13 ]. Elbow stiffness and posterior interosseous nerve palsy were the complications encountered in our series.…”

Section: Discussionmentioning

confidence: 99%

“…The available treatment options for Judet type III and type IV radial neck fracture are a) closed reduction and immobilization in a plaster cast, b) percutaneous pin leverage method, c) elastic stable intramedullary d) open reduction with or without internal fixation [7][8][9][10][11][12]. The proximal radial epiphysis has retrograde blood supply as blood vessels enter at metaphysis and supply proximally to the radial epiphysis [13]. Percutaneous pin reduction and open reduction with or without internal fixation may further damage the blood supply and capsule of the elbow joint leading to complications like avascular necrosis of proximal radial epiphysis and elbow stiffness.…”

Section: Introductionmentioning

confidence: 99%

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Study of Short-Term Outcome of Surgically Managed Displaced Pediatric Radial Neck Fractures: A Case Series

Kashayi-Chowdojirao¹,

Chirla²,

Eppakayala³

et al. 2022

Cureus

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Introduction: Pediatric radial neck fractures are relatively rare elbow injuries commonly seen in children between eight to 12 years of age. Judet type III and Judet type IV radial neck fractures require surgical intervention for optimal functional outcomes. The present study evaluates the functional results of Judet type III and IV radial neck fractures operated at a single center.Materials and methods: This is a retrospective study conducted by using medical records of nine patients who had displaced radial neck fractures (Judet type III and type IV) treated at our institute which is a tertiary trauma care center between January 2012 and December 2021. Patients were assessed for functional outcome by Mayo elbow performance score (MEPS), the Tibone and Stoltz functional criteria, and for complications with the average follow-up of four years (range: six months to seven years).Results: The mean age of the patients was 9.14 ± 2.2 years (range: four to 11 years). Seven (77.8%) patients were males and two (22.2%) patients were females. The right side was the most commonly injured side (right at 67%, left at 33%). Five (55%) cases were of Judet type III and four (45%) cases were of Judet type IV. Three cases treated with closed reduction and intramedullary nailing by the Metaizeau technique had excellent functional results. Among two patients treated with percutaneous pin leverage and intramedullary nailing by the Metaizeau technique, one patient had an excellent outcome, and the other had a good outcome. Among four cases treated with open reduction and K-wire fixation, two patients had good outcomes, one patient had a fair outcome, and one patient had a poor outcome. Conclusion:The majority of moderately to severely displaced pediatric radial neck fractures which need intervention can be managed by the closed reduction technique of Metaizeau with or without pin leverage with excellent to good functional outcomes at short-term follow-up. Some cases need open reduction which also has good to fair outcomes. Initial trauma and associated injuries seem to play a role in the outcome rather than the treatment method per se. However, a larger sample size and longer follow-up are needed for comparisons and for arriving at better and definitive conclusions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Study of Short-Term Outcome of Surgically Managed Displaced Pediatric Radial Neck Fractures: A Case Series

Kashayi-Chowdojirao¹,

Chirla²,

Eppakayala³

et al. 2022

Cureus

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“…Fractures to the radial neck and head represent approximately 14% of all pediatric elbow fractures. 24 Radial head fractures have a separate complication profile beyond the scope of this article. Good results are generally observed with simple immobilization if a radial neck fracture is angulated less than 30 degrees and has less than 50% translation.…”

Section: Radial Neck Nonunionmentioning

confidence: 99%

“…29 Additional presentation findings are decreased motion, particularly lack of supination, as well as functional limitations. 24 After the initial diagnosis is confirmed on plain films, a trial of conservative treatment with range of motion exercises is recommended. 30,31 For highly symptomatic patients who fail conservative management, surgical intervention may be warranted, which consists of open reduction internal fixation with or without bone grafting.…”

Section: Radial Neck Nonunionmentioning

confidence: 99%

Management of Malunions and Nonunions Following Elbow Trauma

Shaw¹,

Hire²,

Trauma³

2022

Journal of the Pediatric Orthopaedic Society of North America

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Fractures in children are common in pediatric orthopaedic practice with the majority having positive outcomes with standard treatment. However, complications can develop and clinicians should be aware of common sequelae of pediatric elbow trauma and understand their prevention and treatment. The focus of this article is to provide an overview of common sequelae following pediatric elbow trauma including malunions of supracondylar humerus fractures and nonunion of lateral condyle, radial neck, and medial epicondyle fractures. Key Concepts• Coronal malunions of supracondylar humerus fracture have been largely recognized as cosmetic deformities but do demonstrate a propensity for late lateral condyle fracture and ulnar nerve dysfunction. Corrective osteotomy is the preferred surgical treatment, taking care to orient the osteotomy obliquely to the distal humerus to prevent excessive lateral prominence.• Sagittal plane malunions of supracondylar humerus fractures have the capacity to remodel in patients 5 years and younger but are nearly nonexistent in patients over 8 years.• Lateral condyle nonunion is best prevented by initial treatment based on initial fracture displacement. Established nonunions can be successfully treated with surgical intervention based upon the patient's skeletal maturity, size and location of osseous fragment, and associated deformity.• Radial neck nonunion is a rare complication but one that is particularly challenging for surgical treatment. Non-surgical treatment measures are the preferred treatment approach with surgical treatment reserved for severe cases.

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“…However, this approach neglects the individual angulation (20) of the radial neck and the extent of supination of the forearm and further depends on the quality of the x-ray, which, for example, leads to incorrect measurements when interpreting the anterior-posterior image in pronation. Nevertheless, this angle is applied to determine the displacement of the proximal fragment (21). Therefore, the aim of this retrospective observational study was to present the outcome of a series of pediatric patients with radial head and neck fractures.…”

Section: Introductionmentioning

confidence: 99%

Radial head and neck fractures in children and adolescents

Kalbitz

Lackner²,

Perl³

et al. 2023

Front. Pediatr.

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BackgroundRadial head and neck fractures are a rare entity in pediatric patients. Due to specific characteristics of the blood supply and remodeling potential, the correct diagnosis and initiation of appropriate therapy are crucial for the outcome. Therefore, the aim of this retrospective observational study was to present the outcome of a series of pediatric patients with radial head and neck fractures.MethodsIn total, 67 pediatric and adolescent patients with a fracture of the proximal radius admitted to a Level I Trauma Center (Germany) between 2005 and 2017 were included in this retrospective observational study. Patients were stratified in accordance with the classification of Judet modified by Metaizeau and with the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO-PCCF).ResultsAO-PCCF fracture type of proximal radius was age-dependent. Epiphyseal axis angle and displacement angle correlated significantly. Fractures treated with a K-wire or embrochage centromedullaire elastique stable (ECMES) presented higher displacement angles. The duration of callus formation was dependent on both the reduction technique and fracture displacement. The range of motion after complete fracture consolidation was dependent on the Metaizeau type and reduction technique but independent of the duration of immobilization and physical therapy.Conclusion and clinical relevanceBoth the epiphyseal axis and displacement angle are suitable for measuring the initial fracture displacement in radiographs. Consolidation is dependent on the initial displacement and reduction technique. The mini-open approach leads to a worse reduction result, later callus formation, and a more restricted range of motion in terms of pronation. Furthermore, the range of motion at follow-up is independent of the duration of immobilization and physiotherapy.

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

Cited by 12 publications

References 69 publications

Study of Short-Term Outcome of Surgically Managed Displaced Pediatric Radial Neck Fractures: A Case Series

Study of Short-Term Outcome of Surgically Managed Displaced Pediatric Radial Neck Fractures: A Case Series

Management of Malunions and Nonunions Following Elbow Trauma

Radial head and neck fractures in children and adolescents

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