Details
Category: Volume 06 Issue 07 July 2018
Hits: 1711

Title: Results of displaced radial neck fractures in children treated by Intramedullary elastic nail

Authors: Mohd Iqbal Wani, Hilal Ah Kotwal, Raja Rameez Farooqi

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i7.150

Abstract

Objective: The aim of this study was to report the clinical and radiological results of patients having displaced Judet type 3 radial neck fracture of and fixed with intramedullary elastic nail within 24 hours of trauma.

Methods: There were a total of 15 patients with Judet type 3 severely displaced radial neck fracture. The mean age of the study group was 9.32 years, ranging from 7 to 11 years. Females constituted  60% of the study group.  Closed reduction was achieved by Metaizeau technique using percutaneous K-wire in all cases and fixation done with elastic intramedullary nail passed from distal end of radius. Patients were followed at regular intervals to look for fracture healing and complications if any. Functional evaluation was done at the end of  12 months by elbow range of motion and Mayo Elbow Performance Score (MEPS).

Results: The mean MEPS score increased from 20 points preoperatively to 90 points postoperatively (range, 12 to 95 points). Radiological evaluation revealed that all fractures healed with excellent or good alignment. At the final follow up,  mean flexion was 145 degree  (range, 140 to 150), extension 2 degree (range, 0 to 4), supination 82 degree (range, 80 to 90 ), and pronation 84 degree (range, 80 to 90 ).

Conclusion: Reduction 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 evidence: Level IV, Therapeutic study.

References

  1. Prathapkumar KR, Garg NK, Bruce CE. Elastic stable intramedullary nail fixation for severely displaced fractures of the neck of the radius in children. J Bone Jt Surg Br. 2006 Mar;88(3):358e361.
  2. Gagliardi Ida C, Mouraria GG, Funayama B, Kikuta FK, Cruz MA, Zoppi A. Evaluation of children with radial neck fractures treated with flexible intramedullary nail. Acta Ortop Bras. 2016 MareApr;24(2):81e84.
  3. Ugutmen E, Ozkan K, Ozkan FU, Eceviz E, Altintas F, Unay K. Reduction and fixation of radius neck fractures in children with intramedullary pin. J Pediatr Orthop B. 2010 July;19(4):289e293.
  4. Ursei M, Sales de Gauzy J, Knorr J, Abid A, Darodes P, Cahuzac JP. Surgical treatment of radial neck fractures in children by intramedullary pinning. Acta Orthop Belg. 2006 Apr;72(2):131e137.
  5. Tarallo L, Mugnai R, Fiacchi F, Capra F, Catani F. Management of displaced radial neck fractures in children: percutaneous pinning vs. elastic stable intramedullary nailing. J Orthop Traumatol. 2013 Dec;14(4):291e297.
  6. Steele JA, Graham HK. Angulated radial neck fractures in children. A prospective study of percutaneous reduction. J Bone Jt Surg Br. 1992 Sep;74(5): 760e764.
  7. Metaizeau JP. Reduction and osteosynthesis of radial neck fractures in children by centromedullary pinning. Injury. 2005 February;36(suppl 1):75e77.
  8. Metaizeau JP, Lascombes P, Lemelle JL, Finlayson D, Prevot J. Reduction and fixation of displaced radial neck fractures by closed intramedullary pinning. J Pediatr Orthop. 1993 MayeJun;13(3):355e360.
  9. Judet J, Judet R, Lefranc J. Fracture of the radial head in the child. Ann Chir. 1962 Sep;16:1377e1385.
  10. Judet H, Judet J. Fractures and orthopedique de l' enfant. Paris: Maloine; 1974: 31e39.
  11. Morrey BF, An KN, Chao EYS. Functional evaluation of the elbow. In: Morrey BF, ed. The Elbow and Its Disorders. 2nd ed. Philadelphia: WB Saunders; 1993: 86e89.
  12. Cossio A, Cazzaniga C, Gridavilla G, Gallone D, Zatti G. Paediatric radial neck fractures: one-step percutaneous reduction and fixation. Injury. 2014 Dec;45(suppl 6):80e84.
  13. Radomisli TE, Rosen AL. Controversies regarding radial neck fractures in children. Clin Orthop. 1998 August;353:30e39.
  14. Pring ME. Pediatric radial neck fractures: when and how to fix. J Pediatr Orthop. 2012 Jun;32(suppl 1):14e21.
  15. Schmittenbecher PP, Haevernick B, Herold A, Knorr P, Schmid E. Treatment decision, method of osteosynthesis, and outcome in radial neck fractures in children: a multicenter study. J Pediatr Orthop. 2005 JaneFeb;25(1):45e50.
  16. Pring ME, Wenger DR, Rang M. Elbowdproximal radius and ulna. In: Rang M, Pring ME, Wenger DR, eds. Rang's Children's Fractures. Philadelphia: Lippin-cott Williams & Wilkins; 2005:119e134.
  17. Vocke AK, Von Laer L. Displaced fractures of the radial neck in children: longterm results and prognosis of conservative treatment. J Pediatr Orthop B. 1998 July;7(3):217e222.
  18. Al-Aubaidi Z, Pedersen NW, Nielsen KD. Radial neck fractures in children treated with the centromedullary Metaizeau technique. Injury. 2012 Mar;43(3): 301e305.
  19. Okcu G, Aktuglu K. Surgical treatment of displaced radial neck fractures in children with Metaizeau technique. Ulus Travma Acil Cerrahi Derg. 2007 April;13(2): 122e127.
  20. Tan BH, Mahadev A. Radial neck fractures in children. J Orthop Surg (Hong Kong). 2011 Aug;19(2):209e212.

Corresponding Author

Hilal Ah Kotwal

Postgraduate Department of Orthopaedics, Govt. Medical College Srinagar J&K, India