Late diagnosis and treatment of a paediatric radial neck fracture

Posttraumatic Proximal Radioulnar Synostosis after Closed Reduction for a Radial Neck and Olecranon Fracture

“…In our patient's case, her pattern of injury can be classified as a Monteggia variant fracture; such fractures are characterized by an olecranon fracture with an associated radial neck fracture [ 2 ]. The most common mechanism of injury for Monteggia variant fractures is from fall on an outstretched supinated arm [ 3 , 25 ]. Valgus torque is exerted on the elbow joint which, when combined with the force that is transmitted from the wrist up through the radial shaft, drives the radial head into the capitellum [ 2 , 5 , 20 ].…”

“…Thus, in keeping with current standard of practice [ 1 ], radial neck fractures with <30° angulation and less than 3-4 millimeters of translation are usually best treated with closed reduction and casting. For these cases, closed reduction and casting almost universally provides an optimal reduction and avoids major complications, including PPRUS [ 2 , 3 , 23 – 25 ]. However, though extremely rare, cases of PPRUS after minimally displaced nonoperatively treated radial neck injury have occurred.…”

Neck Osteotomy for Malunion of Neglected Radial Neck Fractures in Children

“…1 During the fall, the energy is dissipated through the upper limb and transmitted through the shaft of the radius with the capitellum being driven against the radial head. As much of the head is cartilage, the valgus force is transmitted to the weaker physis and metaphysis in the neck region.…”

“…11 Subsequent head on neck angulation depends on the position of the radius, with full supination leading to lateral displacement and neutral forearm positioning leading to posterior displacement. 1 On account of the valgus stress pattern, other associated injuries of the elbow may be present, such as greenstick fracture of the olecranon, or avulsion fracture of the medial epicondylar apophysis. [12][13][14][15] In 40% cases, the lesion is isolated 16 and may be difficult to visualize by nonexpert practitioners in pediatric traumatology.…”

“…In children approximately 10 years old, a neck angulation of higher than 30 degrees or a translocation of the fracture segment greater than 3 mm requires closed manipulative reduction or percutaneous wiring to manipulate the fracture. 1 After diagnosis, the results are best if treatment is initiated less than 5 days after the incident 1-3 and reports suggest that closed reduction usually leads to satisfactory results. 4,5 Some investigators have found that open reduction is associated with a fair or poor result owing to the increased incidence of avascular necrosis, 4 proximal radioulnar synostosis, [6][7][8] or myositis ossificans.…”