Elastic stable intramedullary nail fixation for severely displaced fractures of the neck of the radius in children

Abstract

Several techniques are available for the treatment of displaced fractures of the neck of the radius in children. We report our experience in 14 children treated by indirect reduction and fixation using an elastic stable intramedullary nail. The patients were followed up for a mean of 28 months. One developed asymptomatic avascular necrosis. The rest had excellent results. One had a neuropraxia of the posterior interosseous nerve, which recovered within six weeks. We advocate elastic stable intramedullary nailing for the closed reduction and fixation of these fractures in children.

Evaluation of Severely Displaced Radial Neck Fractures in Children Treated With Elastic Stable Intramedullary Nailing

“…2,[5][6][7][8][9] We agree with the majority of authors, who recommend treating fractures with an angulation of less than 30 degrees (Judet type I and II fractures) with immobilization alone and those with more than 30 degrees angulation (Judet type III and IV fractures) by means of reduction. 2,[5][6][7]17 There are several treatment possibilities for Judet type III and IV fractures. Percutaneous pin reduction, 2,10 intramedullary pin reduction with Kirschner wires 2,11,12 or ESIN, 7,13 and open reduction with or without internal fixation 2,6 are all possible treatment modalities.…”

“…2,[5][6][7]17 There are several treatment possibilities for Judet type III and IV fractures. Percutaneous pin reduction, 2,10 intramedullary pin reduction with Kirschner wires 2,11,12 or ESIN, 7,13 and open reduction with or without internal fixation 2,6 are all possible treatment modalities. Fixation with Kirschner wires through the capitellum across the radial head into the neck is not advocated because of the risk of wire breakage, erosion of the joint surface, and avascular necrosis of the radial head.…”

“…The 1 patient who achieved only a good result and developed avascular necrosis was 1 of the 2 individuals treated with open reduction followed by ESIN. 7 Some authors recommend removal of the intramedullary nail or wire after closed reduction has been performed, with the stability of the fracture being examined in pronation and supination. 18,19 The advantage is that no second operative procedure for metal removal is necessary.…”

“…However, we agree with the majority of authors who advocate leaving intramedullary nails to allow early mobilization without a cast. 7,11,12 ESIN is a minimally invasive technique, allowing stable fixation, early mobilization, and anatomical reduction in most cases. The complication rate is low and good-to-excellent results can be expected.…”

“…Minor degrees of angulation can be accepted and treated with immobilization alone, 2,5-7 but advice differs with regard to the degree of acceptable angulation, ranging from 15 to 45 degrees. 2,[5][6][7][8][9] The more severely angulated and displaced fractures can be treated with closed reduction, 2,5 percutaneous pin reduction, 2,10 intramedullary pin reduction with Kirschner wires 2,11,12 or elastic stable intramedullary nailing (ESIN) 7,13 and open reduction with or without internal fixation. 2,6 Open reduction is associated with a high incidence of complications.…”