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

Abstract

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.

Keywords

Radial neck fractures - Children - Percutaneous

• References

• 1 Aufranc OE, Jones WN, Turner RH et al Radial neck fracture in a child. JAMA 1967; 2: 1140-1142
• 2 Judet J, Judet R, Lefranc J. Fracture du col radial chez l’enfant. Ann Chir 1962; 16: 1377-1385
• 3 Vahvanen V, Gripenberg L. Fracture of the radial neck in children. Acta Orthop Scand 1978; 49: 32-38
• 4 Steele JA, Graham HK. Angulated radial neck fractures in children. A prospective study of percutaneous reduction. J Bone Joint Surg 1992; 74-B: 760-764
• 5 Newman JH. Displaced radial neck fractures in children. Injury 1977; 9: 114-121
• 6 Bernstein SM, McKeever P, Bernstein L. Percutaneous reduction of displaced radial neck fractures in children. J Pediatr Orthop 1993; 13: 85-88
• 7 Cha SM, Shin HD, Kim KC et al Percutaneous reduction and leverage fixation using K-wires in paediatric angulated radial neck fractures. Int Orthop 2012; 36 (4) 803-809
• 8 Stiefel D, Meuli M, Altermatt S. Fractures of the neck of the radius in children, early experience with intramedullary pinning. J Bone Joint Surg 2001; 83-B: 536-541
• 9 Radomisli TE, Rosen AL. Controversies regarding radial neck fractures in children. Clin Orthop 1998; 353: 30-39
• 10 Futami T, Tsukamoto Y, Itoman M. Percutaneous reduction of displaced radial neck fractures. J Shoulder Elb Surg 1995; 4 (3) 162-167
• 11 Metaizeau JP, Lascombes P, Lemelle JL et al Reduction and fixation of displaced radial neck fractures by closed intramedullary pinning. J Pediatr Orthop 1993; 13: 355-360
• 12 Kapandji A. Intra-focal pinning of fractures ofthe distal end of the radius 10 years later. Ann Chir Main 1987; 6: 57-63
• 13 Tarallo L, Mugnai R, Fiacch F. Management of displaced radial neck fractures in children: percutaneous pinning vs. elastic stable intramedullary nailing. J Orthop Traumatol 2013; 14: 291-297