Radial head fracture associated with posterior interosseous nerve injury

Terra, Bernardo Barcellos; Sassine, Tannus Jorge; Lima, Guilherme de Freitas; Rodrigues, Leandro Marano; Padua, David Victoria Hoffmann; Nadai, Anderson De

doi:10.1016/j.rboe.2016.10.002

Cited by 6 publications

(10 citation statements)

References 11 publications

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“…Naturally, traumas at this level such as radial head or neck fractures or fractures of the proximal shaft of the radius also carry the risk of PIN injury. However, only few cases of PIN injury after fractures of the radial head or neck have been described (Table 1) [[3], [4], [5], [6], [7]]. Of these five reported cases, the PIN injury was treated non-operatively in four and in only one case PIN release was performed.…”

Section: Discussionmentioning

confidence: 99%

“…One patient was lost to follow-up and outcomes are unknown. All other four patients reported complete recovery after various follow-up (range 2 days–6 months) [[3], [4], [5], [6], [7]].…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of PIN palsy in fractures with a non- or minimally displaced radial head has not been fully clarified. Possible theories include PIN compression by edematous surrounding tissue or fracture hematoma, direct damage from a fractured radius fragment and iatrogenic damage during closed reduction [[3], [4], [5], [6], [7]].…”

Section: Discussionmentioning

confidence: 99%

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Posterior interosseous nerve palsy after closed proximal forearm fractures

Bulstra

Schep

Vlies

2019

Trauma Case Reports

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Although rare, posterior interosseous nerve (PIN) palsy can occur in patients with a closed proximal forearm fracture and may present in a delayed fashion after initial trauma. In this case series, three cases of posterior interosseous nerve (PIN) injury following proximal forearm fractures are presented and discussed. Our literature search yielded six studies concerning PIN injury in radial head/neck fractures and proximal forearm fractures. Out of a total of 8 patients, 7 patients were treated non-operatively and in one patient a PIN release was performed. One patient was lost to follow-up, all other 7 patients showed successful recovery. A treatment algorithm for PIN palsy after proximal forearm fractures is provided. Based on our experience and what we found in literature, it seems safe to treat PIN palsies conservatively.

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Section: Discussionmentioning

confidence: 99%

“…One patient was lost to follow-up and outcomes are unknown. All other four patients reported complete recovery after various follow-up (range 2 days–6 months) [[3], [4], [5], [6], [7]].…”

Section: Discussionmentioning

confidence: 99%

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Posterior interosseous nerve palsy after closed proximal forearm fractures

Bulstra

Schep

Vlies

2019

Trauma Case Reports

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“…There is tenderness on palpation of the proximal radius[ 2 , 8 , 9 ]. Neurovascular examination should be performed, with specific consideration to the posterior interosseous nerve[ 10 , 11 ]. Attention should also be paid to soft-tissue swelling to assess the rare risk of forearm compartment syndrome[ 12 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

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

Macken

Eygendaal

Bergen

2022

WJO

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Radial head and neck fractures represent up to 14% of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient. In up to 39% of proximal radius fractures, there is a concomitant fracture, which can easily be overlooked on the initial standard radiographs. The treatment options for proximal radius fractures in children range from non-surgical treatment, such as immobilization alone and closed reduction followed by immobilization, to more invasive options, including closed reduction with percutaneous pinning and open reduction with internal fixation. The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient; an angulation of less than 30 degrees and translation of less than 50% is generally accepted, whereas a higher degree of displacement is considered an indication for surgical intervention. Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures, range of motion and complications compared to severely displaced fractures requiring surgical intervention. With proper management, good to excellent results are achieved in most cases, and long-term sequelae are rare. However, severe complications do occur, including radio-ulnar synostosis, osteonecrosis, rotational impairment, and premature physeal closure with a malformation of the radial head as a result, especially after more invasive procedures. Adequate follow-up is therefore warranted.

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“…Closed surgeries using various reduction techniques, including percutaneous pin or intramedullary elastic nails, have been proposed [ 1 – 8 ]. However, concerns about inadequate reduction, epiphyseal damage, and posterior interosseous nerve injury have emerged [ 4 , 9 ]. The radial head start to ossify from around age 5 years; if the radial head is mostly cartilaginous, it may be difficult to visualize on radiography.…”

Section: Introductionmentioning

confidence: 99%

Ultrasonography-guided reduction of pediatric radial neck fractures

Lee

Kim

Choi

2017

BMC Musculoskelet Disord

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BackgroundTreatment of displaced and angulated radial neck fractures in children is controversial and challenging. Numerous studies have been conducted regarding treatment algorithms and surgical techniques that use fluoroscopy. However, ultrasonography (US)-guided reduction of pediatric radial neck fractures has not been reported yet. We aimed to determine the safety and efficacy of US-guided reduction and fixation of radial neck fractures in children.MethodsAmong 28 cases of radial neck fracture from 2014 to 2016, 12 were classified as type III or IV according to the Judet classification. All 12 patients underwent US-guided reduction and percutaneous fixation with Kirschner wire and follow-up for more than 6 months. US was used primarily to monitor the angulation and reduction of the radial neck. Fluoroscopy was applied to confirm the fixation with Kirschner wire. Dose area product (DAP; mGy/cm2) was measured to assess per-procedure radiation dose. Radiological and clinical results were evaluated at 6 months after the surgery by using the Metaizeau criteria.ResultsOf the patients, 4 were boys and 8 were girls, with a mean age of 7.7 years (range, 5–11 years). Judet type III fractures accounted for 83% of all injuries. The mean preoperative radial angulation was 62.5° (range: 46°–76°). The mean postoperative radial angulation was 5.6° (range: 2°–9°). The mean fluoroscopy time was 31 s (range: 10–73 s), and the mean DAP was 10.7 mGy/cm2 (range: 7.2–18.7 mGy/cm2). The mean follow-up period was 18.3 months (range, 8–24 months). According to the Metaizeau criteria, 10 cases were excellent and 2 cases were good at the last follow-up.ConclusionsUS-guided reduction and percutaneous fixation is safe and reliable option to treat displaced radial neck fractures in children.

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Radial head fracture associated with posterior interosseous nerve injury

Cited by 6 publications

References 11 publications

Posterior interosseous nerve palsy after closed proximal forearm fractures

Posterior interosseous nerve palsy after closed proximal forearm fractures

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

Ultrasonography-guided reduction of pediatric radial neck fractures

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