Treatment of Severely Displaced Radial Neck Fractures in Children With Percutaneous K-wire Leverage and Closed Intramedullary Pinning

Zhang, Fu-Yong; Wang, Xiaodong; Zhen, Yunfang; Guo, Zhi‐Xin; Dai, Jin; Zhu, Ling

doi:10.1097/md.0000000000002346

Cited by 19 publications

(24 citation statements)

References 25 publications

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“…In 1980, Métaizeau 16 was the first to report the use of a closed reduction of the intramedullary nail to treat the radial fracture in children, with good postoperative efficacy. For radial fracture with severe displacement and angulation, however, it can be difficult to achieve reduction using the Métaizeau technique alone, 5,7,10 and the use of open reduction has therefore been advocated in these cases. 17…”

Section: Resultsmentioning

confidence: 99%

“…Radial neck fracture is common in children, accounting for approximately 1%–2.7% of all children’s fractures and 5%–10% of elbow fractures. 1–5 Severely displaced Judet IV radial neck fractures are not easy to treat using minimally invasive methods such as the Métaizeau technique and single Kirschner (k)-wire percutaneous leverage reduction, 2,4–7 while open reduction may aggravate the elbow injury, increase the risk of radial necrosis and non-union, and decrease treatment effectiveness. 3,8,9 Furthermore, some researchers have suggested that open reduction does not influence the overall treatment effectiveness of radial neck fracture.…”

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confidence: 99%

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Percutaneous leverage reduction with two Kirschner wires combined with the Métaizeau technique versus open reduction plus internal fixation with a single Kirschner-wire for treating Judet IV radial neck fractures in children

Xiong

et al. 2019

J Int Med Res

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ObjectiveTo compare the clinical effectiveness of a novel approach, percutaneous leverage reduction using two Kirschner-wires (k-wires) combined with the Métaizeau technique, versus open reduction plus internal fixation with k-wire for the treatment of Judet IV radial neck fractures in children.MethodsThirty-four patients with Judet IV radial neck fractures were treated either with percutaneous leverage reduction using two k-wires and the Métaizeau technique (n = 16) or open reduction plus internal fixation with k-wire (n = 18). Patient data including sex, age, time from trauma to surgery, fracture type, follow up, postoperative healing time, X-ray studies, elbow function, and complications were collected.ResultsThere were no significant differences in patient characteristics between the two treatment groups. In postoperative elbow function assessment, 93.8% of patients in the group that underwent the novel treatment approach had a score of excellent or good, compared with 83.3% of patients in the open reduction and internal fixation with k-wire group. Furthermore, no postoperative complications were reported in patients in the novel treatment group, compared with 5 patients in the open reduction and internal fixation with k-wire group. All patients in both groups were classified as excellent or good according to Métaizeau criteria in postoperative X-ray assessment.ConclusionsCompared with the open reduction and internal fixation with k-wire approach, percutaneous leverage reduction using two k-wires combined with the Métaizeau technique can significantly increase the minimally invasive reduction rate, and represents an attractive strategy for the treatment of Judet IV radial neck fractures in children.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Percutaneous leverage reduction with two Kirschner wires combined with the Métaizeau technique versus open reduction plus internal fixation with a single Kirschner-wire for treating Judet IV radial neck fractures in children

Xiong

et al. 2019

J Int Med Res

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“…In 1993, Metaizeau et al reported intramedullary nailing as a surgical option for the treatment of displaced radial neck fractures [4]. The main superiority of intramedullary fixation is that it simultaneously allows for accurate and stable reduction without disturbing the blood supply [20]. However, this treatment must be performed carefully to protect the superficial branch of the radial nerve and the radial physis [21].…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, most surgeons agreed that closed reduction might fail in severely displaced fractures [1, 20, 21]. However, few of those authors analyzed why the closed reduction failed and how closed reduction can be achieved for the failed cases.…”

Section: Discussionmentioning

confidence: 99%

Closed reduction of severely displaced radial neck fractures in children

Qiao

Jiang

2019

BMC Musculoskelet Disord

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BackgroundSeverely displaced radial neck fractures in skeletally immature children are rare and can be difficult to reduce. The purpose of this study is to evaluate the results using our reduction maneuver.MethodsFrom October 2011 to December 2015, 26 children with radial neck fractures(O’Brien type II, III and Judet type III, IV) were treated at our institute. All patients underwent percutaneous K-wire leverage and radial intramedullary pinning in an average surgery time of 35 mins (15–80 min). The injured arm was immobilized at the functional position with plaster for 4–6 weeks, evaluated clinically and radiologically. The Metaizeau classification and Mayo elbow performance score were used to evaluate the radiological and clinical results, respectively. Percutaneous K-wire leverage and radial intramedullary pinning were performed for 26 patients. No patients were treated with open reduction. Twenty four patients were followed up for a mean of 33 (range 12–53 months) months.ResultsThere were 15 girls and 9 boys with ages ranging from 1.5 to 12 years and an average age of 7.2 years. Percutaneous K-wire leverage reduction and intramedullary pinning were successfully used in an average total surgery time of 35 mins (range 15–80 min). In total, 2 cases (O’Brien type III and Judet type IVb, angulation = 90°) needed the additional maneuver. Bone union was achieved in all patients within a mean time of 4.2 weeks. The clinical results were evaluated basing on the Mayo elbow performance score, and there were 23 excellent results and one good result. There were no refractures and no incidences of nonunion, suture infection, iatrogenic radial nerve injury, asymptomatic enlargements of the radial head or growth arrest in the proximal radial epiphysis.ConclusionOur modified percutaneous leverage technique with radial intramedullary fixation may be successfully used to avoid open reduction.

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“…It is reported that either the acceptable value of radial neck angle after the operation should be under 20° that the reduction was adequate. 2 , 5 , 7 , 21 Any residual tilt more than 20° was related with the poor outcomes, which could affect functional results adversely. In our study, all reductions were anatomically which was supported by excellent results.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary elastic nailing of the displaced radial neck fractures in children

Koca¹,

Erdem²,

Neyisci³

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to report the clinical and radiological results of 11 patients with Judet type 3 severely displaced radial neck fractures, who were treated with intramedullary elastic nail fixation with the help of percutaneous K-wire reduction maneuver (Métaizeau technique).MethodsA total of 11 children (4 boys and 7 girls with a mean age of 7.7 (6–10) years) with Judet type 3 radial neck fractures were treated in our clinic between February 2013 and August 2015. The fractures were evaluated according to Judet classification system modified by Métaizeau. Reduction and fixation was performed within the first 24 h after injury in all patients. All fractures were treated by closed reduction using distal elastic intramedullary nail. Clinical evaluation was performed by measuring elbow range of motion (ROM) with goniometer, radiological evaluation by assessing fracture healing and functional evaluation by using Mayo Elbow Performance Score (MEPS).ResultsThe mean MEPS score increased from 15 points preoperatively to 88 points postoperatively (range, 12–95 points). Radiological evaluation revealed that all fractures healed with excellent or good alignment. The mean flexion was 150° (range, 145–154°), extension 1° (range, 0–2°), supination 82° (range, 80–86°), and pronation 83° (range, 80–85°).ConclusionReduction and osteosynthesis of radial neck fractures by intramedullary nailing with the help of percutaneous K-wire manipulation appears to be a simple, safe and effective treatment method in children.Level of evidenceLevel IV, Therapeutic study.

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Treatment of Severely Displaced Radial Neck Fractures in Children With Percutaneous K-wire Leverage and Closed Intramedullary Pinning

Cited by 19 publications

References 25 publications

Percutaneous leverage reduction with two Kirschner wires combined with the Métaizeau technique versus open reduction plus internal fixation with a single Kirschner-wire for treating Judet IV radial neck fractures in children

Percutaneous leverage reduction with two Kirschner wires combined with the Métaizeau technique versus open reduction plus internal fixation with a single Kirschner-wire for treating Judet IV radial neck fractures in children

Closed reduction of severely displaced radial neck fractures in children

Intramedullary elastic nailing of the displaced radial neck fractures in children

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