Radial neck fracture in children: anatomic and functional results of Metaizeau technique

Abstract

Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children.

The Effects of Using K-Wire or Titanium Elastic Nails on Clinical and Radiological Outcomes in the Métaizeau Closed Reduction Technique

“…There was no statistically significant difference in complication rates between the TEN and K wire groups. At the same time, the radiographic and functional outcomes of the patients in this study were consistent with previously published studies [ 13 , 16 , 17 ]. When we analyzed the costs of the two groups, we found significant differences.…”

“…By including only Judet Type 4 fractures in our study, we eliminated any effect of fracture type on treatment outcomes. Additionally, we used the Métaizeau closed reduction technique, which has gained popularity in recent years [ 12 , 13 ], as a surgical technique.…”

“…There is a study comparing TEN and K-wire in the surgical treatment of various fractures [ 14 ]. Although studies describe and compare surgical methods for the treatment of PRNFs in the literature [ 12 , 13 , 15 ], there is no study evaluating the properties of the implant in the Métaizeau closed reduction technique. In this study, we evaluated the outcomes of patients who underwent surgery with the Métaizeau closed reduction technique due to Judet Type 4 PRNF based on the characteristics of the implant utilized during the surgery.…”

Pediatric Radial Neck Fractures: A Systematic Review Regarding the Influence of Fracture Treatment on Elbow Function

“…Twenty-six case series provided sufficient data regarding angulation at trauma, treatment details, and elbow ROM at follow-up [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. The main characteristics of the included studies are listed in Table 3 .…”

“…Treatment options consisted of cast immobilization without reduction; closed reduction [ 26 , 27 ], which may be aided by leverage of a percutaneous pin [ 61 ]; K-wire fixation (either transcapitellar [ 18 , 62 ], across the fracture [ 41 ], by percutaneous K-wire leverage and pinning [ 15 , 16 , 19 , 29 , 33 , 46 , 49 , 52 ]); intramedullary K-wire [ 24 , 32 ]; Nancy nail or Titanium elastic nail (TEN) [ 11 , 13 , 22 , 23 , 25 , 28 , 34 , 36 , 54 , 55 ] combined techniques such as CIMP assisted by Kw leverage [ 14 , 17 , 30 , 43 , 50 , 53 , 57 ]; open reduction only [ 8 ]; or the description of several treatments [ 20 , 21 , 31 , 35 , 37 , 38 , 39 , 42 , 45 , 47 , 56 , 59 , 60 ]. Some included (slight) adjustments to established techniques [ 12 , 58 ].…”