Fractures of the neck of the radius in children. Early experience with intramedullary pinning

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

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.

Radial neck fractures in children: A surgical tip using the Metaizeau technique to improve stability of the reduction

Aim

To evaluate early results of management of radial neck fractures with Métaizeau technique in the paediatric age group and to elaborate on a surgical tip to improve stability of the fixation.

Method

A retrospective analysis of 21 patients, with fracture radial neck, who underwent closed reduction and internal fixation with elastic intramedullary nailing (Métaizeau technique), was performed. Mean age at injury was eight years, and the average follow-up was 4.5 months (range: 3-6 months). Follow up Clinical and radiological evaluation was performed at first and sixth postoperative weeks. At six weeks following removal of the nail, a clinical assessment was conducted to record the outcomes, and any later follow-up was arranged based on pain and range of motion.

Results

We recorded five excellent, eight good, one fair, results for type 3 fractures. For type 4 fractures, we had one excellent, five good and one fair, results. Altogether, we recorded 20 (90.5%) excellent or good results, and 2 (9.5%) fair results. Complications noted were superficial skin infection at the entry site in one patient that required a course of oral antibiotics. Prominent metal work was noticed in 14 cases, which didn't need any further intervention as it did not cause any functional discomfort.

Conclusion

With Metaizeau technique, there were reported poor results of about 10% in literature. In our study, with the modification of the shape of the nail tip, we have managed to achieve stable fixation of the reduction without any loss of position and consequently, better outcomes.

The effectiveness of a modified Metaizeau technique in fixation of adult radial neck fractures: a prospective study with a modification of the Broberg-Morrey classification

BACKGROUND

The incidence of adult radial neck fractures is lower compared with its pediatric counterpart. The literature on adult radial neck fracture management is limited; also, there is a lack of a detailed fracture classification system. In our study, we are evaluating the modified Metaizeau technique for the treatment of adult radial neck fractures. We also describe a modification to the existing fracture classification proposed by Broberg and Morrey to make it more inclusive of different fracture patterns.

MATERIALS AND METHODS

This is a prospective case series in which we included all the patients who presented to us with adult radial neck fractures. We used a modified Metaizeau technique to treat these fractures. Postoperatively, patients were followed up for a minimum duration of 1 year with a visual analog scale score, the Mayo Elbow Performance Score, the Oxford Elbow Score, the Disabilities of the Arm, Shoulder, and Hand score, and a subjective satisfaction questionnaire.

RESULTS

We included a total of 7 patients who had completed follow-up of 1 year. Of the total 7 cases, 3 cases had an associated radial head fracture (undisplaced), and 1 had an associated radial shaft fracture (segmental pattern). Elastic nails were removed at 6 weeks, and all fractures united. The subjects returned to their preinjury activity levels by the end of 3 months and had excellent outcomes as measured by various outcome scores.

CONCLUSION

The modified Metaizeau technique for closed reduction and internal fixation of adult radial neck fractures is effective and simple and has no complications compared with other treatment methods. However, further studies with larger sample sizes are needed to arrive at a more meaningful conclusion.

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

Background and purpose - Heavily 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 methods - We 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). Results - The 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. Interpretation - The 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.

Management of Displaced Radial Neck Fractures with Closed Technique using Titanium Elastic Nail and Review of Literature: A Case Report

Introduction:

Injuries around the elbow are common in pediatric population. Amongst them, most common is fractures of the supracondylar part of humerus, followed by condylar fractures. Fractures of the neck of the radius account for five-ten percent of the total injuries. Various techniques for closed reduction of the fracture have been described in literature. Open reduction and fixation is indicated when closed reduction fails to provide satisfactory results and the angulation remains more than 45-60 degrees.

Case Report:

We present two cases of severely displaced radial neck fractures treated with closed reduction and intramedullary fixation using titanium elastic nails. The distal bent tip of the nail is used to maneuver the proximal rotated fragment and to reduce it back in its place.

Conclusion:

It is an indirect closed reduction technique and associated with minimal intra and post-operative complications and gives encouraging results. It gives stable fixation and also prevents re-displacement after nail removal.

EVALUATION OF CHILDREN WITH RADIAL NECK FRACTURES TREATED WITH FLEXIBLE INTRAMEDULLARY NAIL

Objective

: To evaluate the results of displaced radial neck fractures in children trated surgically with flexible titanium intramedullary nails.

Method

: This is a retrospective study of five cases of radial neck fractures with displacement greater than 30° fixed with flexible intramedullary nails. Patients were evaluated regarding functional outcome through range of motion and the Mayo Elbow Performance Score (MEPS), as well as radiographic exams.

Results

: Five patients, with a mean age of 8.4 years were assessed, during a mean post-operative follow up of 12.2 months. Open reduction was necessary in three cases with major displacement. At the end of the follow up, 80% of the patients had excellent results, 20% good results, and all fractures healed. As complications we observed: heterotopic ossification, superficial infection and radial head necrosis.

Conclusions

: In spite of the small sample, our results with flexible titanium intramedullary nails were similar to the current literature, with good functional outcomes. Level of Evidence III, Retrospective Study.

Percutaneous Reduction and Fixation Using Two K-wires In Paediatric Angulated Radial Neck Fractures

BACKGROUND

Fractures of the radial neck in children are usually seen at about the age of five years, after the appearance of the proximal radial epiphysis. They are usually caused by a fall on the outstretched hand which produces a valgus strain [1]. Minor degrees of angulation can be accepted and treated conservatively, but advice on the maximum acceptable angulation varies widely, up to as much as 45°0 [2] More severely angulated and displaced fractures have been variously treated by closed or open reduction, but the precise indications for each are not clear [3]. In a retrospective study Steele et al. found that open reduction generally had a poor result and that open reduction with internal fixation was even worse, as has been reported by others [4, 5].

METHODS

We describe a modified percutaneous technique using two (1.6 mm) K-wires for reduction (one wire for leverage and one wire for translation) and two K-wires for rotationally stable fixation.

RESULTS

Nine patients were included in the study. The median age of the patients was 9.6 years. There were six males and three females. The average follow up period was 23 months. The final results of the study included six patients with excellent results and one with a good result. Unfortunately, two patients were visitors and failed to attend for review.

CONCLUSION

We have found this technique effective and easily reproducible. Level of evidence IV - Case series.

Radial neck fractures in children treated with the centromedullary Métaizeau technique

BACKGROUND

Radial neck fracture in children is infrequent but when not managed accurately can lead to complications. Different methods have been developed for the reduction and fixation of this fracture. The purpose of this retrospective study is to evaluate our results using the Métaizeau centromedullary technique.

MATERIALS AND METHOD

Our series comprises 19 children with displaced radial neck fractures treated in our institution in the period 2004-2008. One patient was excluded because of a very complex fracture dislocation of the elbow (exclusion criteria). Two patients refused to participate in the follow-up leaving 16 who were treated with this technique. Patients were evaluated clinically and radiologically. For the clinical evaluation, we used the Métaizeau's classification. The subjective evaluation was done using the DASH score, and the Steele's classification was used for the evaluation of the radiological results. FINDING/RESULTS: We found good clinical and radiological outcomes. The mean DASH score was 3.06. Patients who had undergone open reduction had inferior outcome.

CONCLUSION

Our results are comparable to other studies. This study confirms the Métaizeau technique as an excellent treatment option for displaced paediatric radial neck fractures.

Fell on outstretched hand

Radial neck fractures in children are not uncommon. Most are minimally displaced or nondisplaced. Severely displaced fractures or angulated radial neck fractures in children often have poor outcomes, especially if not reduced, and even after open reduction.