Radial Neck Fractures in Children and Adolescents

Mattos, Camila Bonati; Ramski, David E.; Kushare, Indranil; Angsanuntsukh, Chanika; Flynn, John M.

doi:10.1097/bpo.0000000000000387

Cited by 42 publications

(26 citation statements)

References 18 publications

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“…[3] However, more complications will be seen when operative management is required. [4] The complications of these fractures reported in children include avascular necrosis, early physeal closure, elbow stiffness, periarticular ossification, and overgrowth of the radius head.…”

Section: Discussionmentioning

confidence: 99%

Closed reduction using the percutaneous leverage technique and internal fixation with K-wires to treat angulated radial neck fractures in children-case report

Jiang

Dang

et al. 2017

Medicine

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Pediatric radial neck fractures are uncommon. Severely displaced and angulated fractures usually require treatment. Our goals for treatment are to avoid incision, reduce the fracture adequately with no reduction loss, and achieve good postoperative function. We aimed to observe the clinical outcomes of closed reduction with the percutaneous leverage technique and internal fixation with Kirschner-wires (K-wires) to treat angulated radial neck fractures in children.From January 2011 to April 2013, we treated 16 cases of angulated radial neck fracture in 12 boys and 4 girls. Five fractures were type II and 11 fractures were type III using the O’Brien classification. One K-wire was percutaneously introduced into the fracture site using the leverage technique to attain good reduction. Two K-wires were introduced from the proximal to the distal areas of the fracture site. The elbow was immobilized by cast in 90° of flexion and the forearm in supination for 3 to 4 weeks. The K-wires were removed at 3 to 4 weeks postoperatively. All cases were followed up for a mean duration of 3 years 6 months.According to the Metaizeau reduction classification, 12 cases were excellent, and 4 cases were good. According to the Metaizeau clinical classification, 14 cases were excellent, and 2 cases were good. There was no necrosis of the radial head. There was no infection, radioulnar synostosis, and damage of the radial nerve deep branch. There was no limitation in the pronation and supination functions of the forearm.Closed reduction using the percutaneous leverage technique and internal fixation using K-wires is easy to perform. It is encouraged to use this approach as the clinical outcome is good.Level of evidence: level IV-retrospective case, treatment study.

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Section: Discussionmentioning

confidence: 99%

Closed reduction using the percutaneous leverage technique and internal fixation with K-wires to treat angulated radial neck fractures in children-case report

Jiang

Dang

et al. 2017

Medicine

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“…For instance, De Mattos et al. ( 2016 ) reported on 193 consecutive children with radial neck fractures, 13% of whom required operative treatment. The authors could show that open reduction increased the risk of fair and poor outcome and that final outcomes were not related to preoperative displacement and the presence of associated injures.…”

Section: Discussionmentioning

confidence: 99%

Judet type-IV radial neck fractures in children: Comparison of the outcome of fractures with and without bony contact

et al. 2016

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Background and purposeHeavily displaced radial neck fractures in children are sometimes associated with poor outcome. A substantial number of these fractures require open reduction. We hypothesized that Judet type-IV fractures with a completely displaced radial head would result in a worse outcome than radial neck fractures with remaining bony contact.Patients and methodsWe analyzed 19 children (median age 9.7 (4–13) years) who were treated for Judet type-IV radial neck fractures between 2001 and 2014. The outcome was assessed at the latest outpatient visit using the Linscheid-Wheeler score at a median time of 3.5 (1–8) years after injury. The patients were assigned either to group A (9 fractures with remaining bony contact between the radial head and the radial neck) or to group B (10 fractures without any bony contact).ResultsThe 2 groups were similar concerning age and sex. The rate of additional injuries was higher in group B (7/10 vs. 1/9 in group A; p = 0.009). The rate of open reduction was higher in group B (5/10 vs. 0/9 in group A; p = 0.01). Poor outcome was more common in group B (4/10 vs. 0/9 in group A; p = 0.03). In group B, the proportion of children with poor outcome (almost half) was the same irrespective of whether open or closed reduction had been done.InterpretationThe main causes of unfavorable results of radial neck fracture in children appear to be related to the energy of the injury and the amount of displacement—and not to whether open reduction was used.

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“…Therefore, a substantial amount of malunited fractures, especially those with rotational errors, may have been missed. Some patients with apparently little residual deformity showed poor results 3,5,8 , which might support this assumption.…”

Section: Introductionmentioning

confidence: 78%

“…Radial neck fractures represent 5-10% of all pediatric elbow injuries [1][2][3] . There is common agreement that the treatment algorithm should be based on the initial displacement and angulation deformity of the fracture [4][5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, there is no clear consensus what amount of residual deformity is deemed acceptable, with thresholds ranging from 15° to 45°5 ,7,9,10 . Regardless the initial fracture treatment, fair to poor outcomes have been documented after 9-32% of all radial neck fractures [3][4][5][6][7] . Possible complications are avascular necrosis and overgrowth of the radial head, radioulnar synostosis and symptomatic malunions 7 .…”

Section: Introductionmentioning

confidence: 99%

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Computer-Assisted Corrective Osteotomy of Malunited Pediatric Radial Neck Fractures—Three-Dimensional Postoperative Accuracy and Clinical Outcome

Weigelt

Fürnstahl

Schweizer

2017

Journal of Orthopaedic Trauma

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Neglected or incorrect treatment of pediatric radial neck fractures may lead to symptomatic malunions. Computer-assisted corrective osteotomies with patient-specific guides have been proposed as a promising technique for the reconstruction of malunited long bone deformities. The aim of this study was to evaluate the accuracy and clinical outcome of this technique in children with malunited fractures of the radial neck. Four children [2 boys, 2 girls; mean age 12 (10-16) years] underwent computer-assisted closing wedge osteotomy of the radial neck. The contralateral uninjured side was used as a reconstruction template. Computed tomography were performed 8 weeks postoperatively to confirm bony consolidation and to quantify residual 3D rotational and translational displacement error. Clinical outcome [pain, range of motion (ROM)] and overall satisfaction were documented. Preoperative subluxation of the radial head could be corrected in 2 of 3 patients. One patient had to be revised because of secondary traumatic loss of reduction. At the last follow-up [mean 16 (range, 12-24) months], all patients were pain free for activities of daily living (preoperative pain: visual analog scale 6). Pain during sport activities could be substantially reduced (visual analog scale 8→2). Although the procedure failed to improve ROM, none of the patients had limitations regarding work, daily, or sports activities. Yet, restricted ROM was considered as a cosmetic problem in 1 patient. Full consolidation of the osteotomy site, with no signs of avascular necrosis of the radial head, was achieved in all patients. The deformity could be substantially reduced, from a 3D angle of 13-40 degrees to 3-7 degrees (58%-89% deformity correction). Computer-assisted corrective osteotomy is a novel technique for the treatment of radial neck malunions that led to adequate pain reduction and 3D accuracy of deformity correction in our small case series. Despite the lack of improved ROM, all patients were satisfied and would undergo the same procedure again.

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Radial Neck Fractures in Children and Adolescents

Abstract: Level III—therapeutic.

Cited by 42 publications

References 18 publications

Closed reduction using the percutaneous leverage technique and internal fixation with K-wires to treat angulated radial neck fractures in children-case report

Closed reduction using the percutaneous leverage technique and internal fixation with K-wires to treat angulated radial neck fractures in children-case report

Judet type-IV radial neck fractures in children: Comparison of the outcome of fractures with and without bony contact

Computer-Assisted Corrective Osteotomy of Malunited Pediatric Radial Neck Fractures—Three-Dimensional Postoperative Accuracy and Clinical Outcome

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