Percutaneous treatment of radial neck fractures in adult patients.

INTRODUCTION: Radial neck fractures in adults are rare, but outcomes are often poor. Closed reduction and internal fixation (CRIF) technique has been advocated for the treatment of minimally displaced fractures in children, with a few reports on adult subjects. The aim of the present paper is to investigate mid-term results of a CRIF technique in adults with retrograde intramedullary K-wires in Mason's type II and III fractures. The proposed technique yields to good anatomical reduction of displaced neck fractures, faster rehabilitation, and easier hardware removal after fracture consolidation. MATERIAL AND METHODS: A consecutive series of 17 patients were treated with closed reduction and intramedullary osteosynthesis, and outcomes were retrospectively evaluated. Elbow X-ray (XR) and CT scan were obtained preoperatively. Objective assessment before surgery and at an average 36-month follow-up included active and passive elbow range of motion (ROM). Functional evaluation was carried out through the collection of the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Elbow Self-Assessment Score (ESAS). XR at last follow-up was evaluated. RESULTS: The cohort included 10 males and seven females, with a mean age of 32 years. Patients returned for a follow-up evaluation at a mean of 36 months (range 6-43 m) form the surgery. The DASH score revealed good to excellent outcomes with a mean of 6.32 ± 10.24 points at last follow-up. The ESAS was 98.35 ± 1.89, indicating a non-restricted elbow function. Acceptable radiographic healing was achieved in all patients. CONCLUSIONS: The advocated technique is promising for obtaining good reduction and stabilization, and good to excellent satisfaction for patients. Given the challenging technique, the learning curve could be long and initial results unsatisfactory. More research with larger cohorts and improved study design could be carried out, comparing the technique with the current choice of treatment (ORIF, radial head resection).

Modified Kirschner wire percutaneous rotation prying reduction combined with elastic stable intramedullary nailing in children with Judet IV radial neck fracture.

PURPOSE: This study was to investigate the feasibility and treatment effect of using modified Kirschner wire (K-wire) percutaneous rotation prying reduction combined with Elastic Stable Intramedullary Nailing (ESIN) in children with Judet IV radial neck fracture. METHODS: A retrospective analysis was conducted on 47 children with Judet IV radial neck fracture who underwent treatment with modified K-wire percutaneous rotation prying reduction combined with ESIN from April 2019 to November 2022, including 25 males and 22 females, with an average age of 8.79 years old (ranging from 5 to 14). The study recorded the surgical time, fluoroscopy time, reduction time, and reduction quality evaluated according to the Metaizeau radiological standard. During the last follow-up, the flexion-extension and forearm rotation function of the affected and healthy sides were recorded, and the Mayo Elbow Performance index was used to evaluate the elbow joint function. RESULTS: The average duration of the operation was 25.51 min (ranging from 14 to 43 min), with a mode of 2 reset times (ranging from 1 to 5) and 8 fluoroscopic times (ranging from 4 to 15). Based on the Metaizeau radiological standard for assessing reduction quality, 45 cases were deemed excellent, while 2 cases were considered good. Following 3-4 weeks of postoperative long-arm cast immobilization, exercises were performed to promote elbow joint and forearm rotation. The ESIN was removed after satisfactory fracture healing around 4 months postoperatively. The average follow-up period was 26.79 months (ranging from 5 to 48). At the final follow-up, the range of motion for the affected limb in flexion, extension, pronation, and supination was (140.23 ± 4.80)°, (4.43 ± 3.98)°, (84.09 ± 4.97)°, and (83.83 ± 4.55)°, respectively. There was no statistically significant difference compared to the healthy side, which had a range of motion of (141.36 ± 3.27)°, (5.28 ± 2.25)°, (85.66 ± 3.20)°, and (84.98 ± 2.57)° (P > 0.05). According to the Mayo Elbow Performance index, 44 cases were rated as excellent and 1 case was considered good. CONCLUSION: The modified K-wire percutaneous rotation prying reduction combined with ESIN is an effective treatment for severe radial neck fractures in children. This technique offers several advantages, including the ability to easily "capture" significantly displaced radial heads, achieve rapid and accurate reduction, and reduce radiation exposure.

Comparison of different treatments for children with radial neck fracture and analysis of prognostic factors.

INTRODUCTION: The aim of this was to analyze the effect of different treatment options on radial neck fractures in children and to explore the factors affecting the prognosis of fractures. METHODS: The clinical data of 131 children with radial neck fractures admitted to our hospital from 2010 to 2018 were retrospectively analyzed, and the patients were divided into 6 groups according to treatment methods [manual reduction with Kirschner wires (K-wires) for internal fixation (group A); manual reduction with elastic stable intramedullary nails (ESINs) for internal fixation (group B); leverage reduction with K-wires for internal fixation (group C); leverage reduction with ESINs for internal fixation (group D); manual and leverage reduction with K-wires/ESINs for internal fixation (group E); and open reduction with K-wires/ESINs for internal fixation (group F)]. Postoperative elbow function and complications were analyzed. RESULTS: Among the 131 patients with fractures, the median age was 8 years, the median preoperative angulation was 52°, the follow-up rate was 86.3% (113/131), the average follow-up time was 58.3 months, and the postoperative complication rate was 17.7% (20/113). The comparison among the different treatment groups showed that group B had the best recovery of elbow function, postoperatively, and the lowest postoperative complication rate. Age, duration of hospitalization, and preoperative angulation were independent factors affecting postoperative complications. Older age, longer duration of hospitalization, and higher angulation increase the postoperative complications. CONCLUSION: Different treatment options have different efficacies for radial neck fractures in children, of which manipulative reduction with internal fixation using ESINs can achieve good efficacy and a low postoperative complication rate. Age, duration of hospitalization, and preoperative angulation are independent factors for postoperative complications.

Fractures of the proximal radius in children: management and results of 100 consecutive cases.

INTRODUCTION: Pediatric radial neck and head fractures are rare, accounting for only 1% of all fractures in children. The aim of this study is to describe the management and results of the respective fracture types and different injury characteristics. MATERIALS AND METHODS: This study performs a retrospective data analysis of 100 consecutive patients with a fracture of the proximal radius treated in a single high-volume pediatric trauma center. RESULTS: One hundred patients [mean age 7.5 years (1-15)] were documented with a fracture of the proximal radius between 3/2011 and 12/2019. The gender distribution was 62 girls and 38 boys. Twenty-seven patients had concomitant injuries. Conservative treatment was performed in 63 patients (Judet I = 27; II = 30; III = 6; Mason I = 2) using an above-the-elbow cast for 21 days (6-35). Surgical treatment was performed in 37 patients (Judet II = 3; III = 22; IV = 5; V = 7) using elastic stable intramedullary nailing (ESIN). Open reduction was necessary in five cases, and additional immobilization was performed in 32 cases. Six complications occurred: loss of implant stability (n = 2), healing in malalignment, pseudarthrosis, radioulnar synostosis, and a persisting hypoesthesia at the thumb. As a result, two ESIN osteosynthesis were revised, and one radial head resection was performed. Loss of movement was seen in 11% of cases, overall Mayo elbow performance index (MEPI) was 99.8 (90-100), and none of the patients experienced negative impacts on activities of daily life. CONCLUSIONS: Proximal radial fractures occur predominately without dislocation. Good results are obtained with conservative treatment throughout. In cases with displacement exceeding growth-related correction, ESIN is the undisputed treatment of choice. Open surgery and long immobilization periods should be avoided whenever possible.

Radial neck fracture or Monteggia equivalent lesion: delayed radial head subluxation in an adolescent and review of literature.

BACKGROUND: Monteggia equivalent lesion represents a series of combined elbow and forearm injuries that resemble typical Monteggia fracture either in presentation or mechanism. The term has gradually evolved since its introduction, as sporadic case reports continued to complement it. The aim of this study was to present a furthermore type of that lesion which no previous study had reported and arouse pediatric orthopedists' additional awareness of it. CASE PRESENTATION: A 11-year-old girl, whose injury pattern initially appeared to be a mild radial neck fracture with undisplaced proximal ulnar fracture, and without radial head dislocation, was treated with closed reduction and long-arm splint immobilization. Acceptable results were acquired at first-week follow-up, yet dramatic changes turned up 2 weeks later when the dislocated radial head was found. A further reduction to the fracture and joint site only resulted in a subluxated and incongruous radiocapitellar joint on the three-dimensional computed tomography (3D-CT). Then a definitive operation was performed, which involved a Boyd incision, correction of radial head tilting, opening wedge osteotomy of the proximal ulna and proper fixation respectively. And acceptable results were achieved 1 year later. CONCLUSIONS: This case, with occult proximal ulna fracture, angulated radial neck fracture, subsequent radiocapitellar dislocation, and articular incongruity, was deemed as a rare Monteggia type-one equivalent fracture-dislocation variant rather than an ordinary radial neck fracture and it facilitates further understanding and management of the Monteggia fracture.

Treatment of displaced radial neck fractures under ultrasonographic guidance in children.

PURPOSE: This study aimed to evaluate the feasibility of reduction under ultrasonographic (US) guidance with Kirschner wires (K-wires) and fixation with elastic stable intramedullary nails (ESINs) in the treatment of radial neck fractures (RNFs). METHODS: This retrospective study included 50 children treated for Judet types III and IV RNFs at our hospital from September 2015 to November 2018. Patients were divided into two groups: group A (without US) and group B (with US). Group A patients were treated using the Métaizeau technique; one K-wire was used for reduction under the guidance of X-ray fluoroscopy. Group B patients were treated using the same technique, but under the guidance of US. Post-operative radiographs, elbow function, and complications were analyzed. RESULTS: All patients were followed up over a period of 12 months. Five patients in group A had posterior interosseous nerve (PIN) injury, whereas no patient in group B had PIN injury (p = 0.016). The use of US guidance resulted in lower radiation exposure and shorter operation time. According to the Mayo Elbow Performance Index, there was no significant difference between the two groups (p = 0.814), including post-operative complications (radial head necrosis, fracture displacement, or stiffness). CONCLUSION: US guidance during surgery is feasible to treat Judet type III and IV RNFs. US guidance can significantly reduce X-ray radiation exposure and the risk of PIN injury.

Percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation of angulated radial neck fractures in children.

PURPOSE: To describe clinical and radiographic outcomes after surgical management of angulated radial neck fracture in children. METHODS: Twenty children (aged 2-11 years) with angulated radial neck fracture with more than 30° angulations (Judet type III and IV fractures) were retrospectively reviewed. All the enrolled patients were surgically treated with percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation. Clinical outcomes were evaluated using Tibone and Stoltz score and the Mayo Elbow Performance Score (MEPS). Radiographic outcomes were evaluated with Métaizeau score. Complications were also evaluated. RESULTS: At a mean follow-up of 20 months, no patients showed axial deformity of the upper limb or instability of the elbow. The mean value of the MEPS was 99.2, and excellent clinical results were achieved in 14 patients (73.7%) at Tibone and Stoltz score. The final X-rays showed fracture healing in all patients; furthermore, 75% of patients showed excellent reduction at Métaizeau score. No patient developed complication. There were no iatrogenic nerve injuries or pin infections. CONCLUSIONS: The results demonstrate that percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation of angulated radial neck fracture treatment is a simple, effective, rapid and inexpensive procedure. LEVEL OF EVIDENCE: IV (case series and systematic review of level IV studies).

Closed reduction of severely displaced radial neck fractures in children.

BACKGROUND: Severely 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. METHODS: From 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. RESULTS: There 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. CONCLUSION: Our modified percutaneous leverage technique with radial intramedullary fixation may be successfully used to avoid open reduction.

Complex radial head and neck fractures treated with modern locking plate fixation.

BACKGROUND: Internal fixation of complex radial head and neck (CRHN) fractures is difficult, and postoperative complications are common. This study evaluated elbow function and patient clinical status after internal fixation of CRHN fractures with modern locking plates. METHODS: We included 40 patients with 41 fractures (1 bilateral lesion). In 25 patients (61%), a concomitant injury was found. Patients were an average age of 46 years (range, 22-70 years). The mean follow-up time was 36 months (range, 2-70 months). Postoperative assessments included evaluation of range of motion, functional scores, and radiologic findings. We assessed fracture healing, surgical complications, revision surgery, and the need for metal removal. RESULTS: Of the 34 fractures available for follow-up, 33 (97%) healed well. The mean extension deficit was 6° (range, 0°-30°). The average elbow flexion was 134° (range, 90°-160°), pronation was 70° (range, 30°-90°), and supination was 64° (range, 20°-90°). The Mayo Elbow Performance Score showed a mean of 90 points (range, 65-100 points). We observed no "poor" results. The mean Disability of Arm, Shoulder and Hand score was 16.5 (range, 2.5-58.3; n = 29). All patients continued activity without daily analgesics. There were 12 (34%) complications. In 11 (32%) patients, the plate was removed. CONCLUSIONS: CRHN fractures fixed with modern locking plates and treated as an osseoligamentous lesion exhibited promising midterm results. The new fixation devices represent an improvement in the treatment of this difficult and common fracture while reducing the need for joint replacement or radial head resection. Diagnosis and treatment of concomitant injuries should be emphasized.

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.

Isolated radial neck delayed union/nonunion after conservative treatment in adults: two case reports and a literature review.

BACKGROUND: Treatment recommendations for isolated radial neck delayed union/nonunion are sparse, but include mainly conservative treatment, electro-stimulation, bone grafting, open reduction and internal fixation (ORIF) and radial head resection. The purpose of this study was to perform a literature review on isolated delayed union/nonunion of radial neck fractures and to evaluate the reported outcomes of proposed treatment strategies. Furthermore, we aimed to generate data-based recommendations for this rare pathology. In the second part of this paper, we report two clinical cases of delayed union of isolated radial neck fractures recently treated at the senior authors institution. METHODS: A literature search on PubMed was performed. We selected all papers with a documented delayed union, pseudarthrosis or nonunion of the radial neck. All papers were reviewed for patient demographics, patient occupation, treatment type and timing relative to the initial trauma, X-ray documentation and outcome. The two patients with delayed union after isolated radial neck fractures recently treated at our institution were evaluated for age, mechanism of injury, occupation, treatment and outcome. Clinical and radiological follow-up examinations were performed 6, 12 weeks, and 1 year after initial trauma. Final clinical evaluations included the Mayo Elbow Performance Score (MEPS) [1] and the Disabilities of the Arm, Shoulder and Hand (DASH) Score [2]. RESULTS: We found 17 cases reported in 11 articles matching our selection criteria of isolated radial neck delayed union or nonunion in adult patients. Average age was 55 years (range 29-73 years). The most frequent mechanism of injury was a fall on an outstretched arm from standing height. Initial treatment consisted of an arm sling for 1-4 weeks and physiotherapy. From the 17 included cases, six were operated on due to persistent pain. Three received bone grafts, one was supplemented with additional K-wire fixation, and three had radial head resections. Ten patients were treated conservatively: six were pain free and three were symptomatic at last follow-up; symptoms were not reported for one case. All surgically treated cases were pain free at the last follow-up, average 32 months (range 6-84). Of the conservatively treated group, eight of ten had documented nonunion. The two reported cases from our institution were initially treated conservatively for 4 and 6 months. Both had a radiologically documented delayed union. Both patients were operated on due to persistent pain precluding them from returning to work. At the last follow-up, MEPS and DASH scores were 100 points and 29 in one case and 100 points and 18 in the other, respectively. CONCLUSION: Isolated delayed union or nonunion of the radial neck after conservative treatment in adult patients appears to be rare and often remains asymptomatic. Operative treatment is recommended for symptomatic delayed union/nonunion in patients with altered elbow function [3]. All surgically treated patients in our study with symptomatic delayed unions/nonunions had favorable clinical outcomes.

Comparison of elastic stable intramedullary nailing versus Kirschner wires in treatment of pediatric radial neck fractures.

Purpose: The aim of the study was to compare the different internal fixations between elastic stable intramedullary nailing and Kirschner wires in treatment of angulated radial neck fractures. Methods: We retrospectively reviewed the patients with radial neck fracture without associated injuries who underwent surgery approach in our department during April 2011-March 2020. There were 62 patients meeting all the criteria with complete clinical data, with median age of 7.5 (IQR 5.8-9.5) years, 34 males and 28 females. The preoperative fracture pattern was assessed according to the Judet classification system. Depending on the materials implanted and fixation strategy, the patients could be divided into a Kirschner wire group and an elastic stable intramedullary nailing group. Final functional outcomes of patients were assessed by the Mayo Elbow Performance Score and Tibone-Stoltz functional evaluation classification. Results: The Kirschner wire group included 37 patients, with 4.8 years median follow-up. The elastic stable intramedullary nailing group included 25 patients with 5.9 years median follow-up. There were no significant differences in gender, age, Judet classification, average operative time, Mayo Elbow Performance Score, Tibone-Stoltz classification, or length of hospital stay between groups. However, the time to union in the Kirschner wire group was significantly shorter than that in the elastic stable intramedullary nailing group (p < 0.05). Both groups achieved satisfactory functional and cosmetic results. Conclusion: In the management of pediatric radial neck fractures, both elastic stable intramedullary nailing and Kirschner wire internal fixation have shown equivalent therapeutic results, leading to satisfactory functional outcomes. The selection of the internal fixation approach can be influenced by the patient's fracture characteristics and the surgeon's preferences. Level of evidence: Level III; Retrospective Comparison; Treatment Study.

Pediatric Radial Neck Fracture: A Case Report Along With Surgical Tips on the Metaizeau Technique.

Radial neck fractures in children are an uncommon phenomenon. The Metaizeau technique for closed intramedullary nailing is a well-documented method for treating this type of fracture. We performed the Metaizeau technique for radial neck fracture fixation on a 10-year-old Indian male patient. The original method described by Metaizeau was followed, with surgical adjustments based on our experience to achieve a satisfactory result. This report provides the surgeon performing the Metaizeau technique with simple tips to assist in fracture reduction and fixation and avoid loss of reduction. These include oscillating movements of the T-handle for proximal progression of the nail/K-wire, gentle stabilizing counterforce over the radial head during entry into the proximal epiphysis, and moving the C-arm instead of the elbow during the nailing process for anteroposterior, oblique, and lateral imaging.

Surgical Challenges and Outcomes in Treating a Floating Upper Arm With Multiple Humerus Fractures and Radial Neck Fractures.

Complex humerus fractures associated with high-energy trauma present significant surgical challenges due to their impact on limb functionality and structural integrity. This case report details the treatment of a floating upper arm injury, characterized by multiple humerus fractures and a radial neck fracture, in a 50-year-old male following a vehicular accident. The patient exhibited fractures at the proximal, mid-shaft, and distal segments of the humerus, necessitating an integrated surgical approach to effectively manage these injuries. Dual surgical approaches and perpendicular plating were employed to address the multifaceted nature of the fractures. The patient achieved satisfactory functional recovery, regaining a significant range of motion, which highlights the efficacy of the chosen surgical strategy. This case contributes to the existing literature by illustrating the benefits of specific surgical techniques in managing complex humerus fractures, emphasizing the necessity for meticulous planning and execution to optimize patient outcomes.

Judet type-IV fracture of the proximal end of the radius in a 7-year-old child. A surgical case report of open reduction and percutaneous pinning.

INTRODUCTION: Fractures of the proximal end of the radius are rare and account for 1 % of all childhood fractures. The treatment of the proximal end of the radius in children depends on age, the degree of angular displacement, and the presence of additional injuries. CASE PRESENTATION: This is a case of a 7-year-old child with a 90-degree angular displaced radial neck Judet type-IV fracture treated with open reduction and intramedullary stabilization with Kirschner wire. Follow-up examinations performed 4 and 12 weeks after the operative treatment revealed very good functional and radiological results. DISCUSSION: In fractures of the radial neck with head displacement reaching 90an open reduction is the method of choice. An undoubted advantage of this method is the possibility of achieving a satisfactory reduction and fixation on the fragments. Although other operative treatment techniques including percutaneous K-wire leverage, Metaizeau technique, may be taken into consideration. CONCLUSION: The method of open reduction and pinning is safe and gives good early outcomes as well as long-term results without leading to impairment of function or deformation of the elbow joint.

Predictive factors for open reduction of operatively treated radial neck fractures in children.

INTRODUCTION: Open reduction is a therapeutic option for displaced radial neck fracture in children, which once was considered the last resort because of its potential risk for functional outcomes. This study aimed to identify risk factors for open reduction in operatively treated radial neck fractures in children. PATIENTS AND METHODS: One hundred and thirty-seven patients with displaced radial neck fractures, treated surgically at our department from January 2010 to December 2021 were retrospectively enrolled. Patients' data of age, sex, injury side, obesity, type of fractures, combined fractures, nerve injury, reduction methods, and delay from injury to surgery were reviewed. Univariate analysis and multivariate logistic regression were used to identify independent risk factors and odds ratios of open reduction. RESULTS: Overall, 137 patients (62 females and 75 males) with an average of 8.0 ± 2.2 years were analyzed. There were 62 cases of type III fractures and 75 cases of type IV based on the Judet classification. Thirty-two cases had combined fractures and 19 cases presented with nerve injury. The open reduction rate was 24.1 % (33/137). Univariate analysis indicated obesity, fracture type, and combined fractures were significantly associated with open reduction. (P = 0.039, P = 0.000 and P = 0.000, respectively). While multivariate logistic regression analysis showed that only fracture type (OR, 5.18; CI, 1.63-16.46, p = 0.005) and combined fractures (OR, 7.79; CI, 2.97-20.41, p = 0.000) were independent risk factors for open reduction. CONCLUSIONS: Judet type IV fracture and combined fractures are two significant risk factors for open reduction in operatively treated radial neck fractures in children. These findings will facilitate preoperative decision making, remind surgeons of the risk of failure in closed reduction and the use of new surgical techniques to decrease the open reduction poor outcome rate.

Management and Outcome of Jeffrey Type 2 Fractures in Paediatric Patients: A Case Series and Review of Literature.

Introduction: Fractures of the radial neck are very uncommon in children, accounting for 5-8.5% of all fractures around the elbow in children, and are sometimes found with dislocation of the elbow joint. Jeffery carefully studied and classified these types of radial neck fractures with displaced radial head into several types. Very few cases with Jeffrey fractures are reported in the literature, and most cases were treated by surgery. Only one case of successful closed reduction and cast and two cases of closed reduction and percutaneous pinning have been reported. Case Report: We report two cases of Jeffery Type 2 fractures treated by an open reduction in an 11-year-old and a 13-year-old boy. We describe the difficulties faced in the reduction of the fracture and the complications that occurred in the patients. Conclusion: Jeffery Type 2 fracture is an uncommon and difficult-to-treat injury with the possible complication of the radial head being turned upside down if treated conservatively. Therefore, prompt recognition and careful reduction are essential in this type of injury.

Opening Wedge Osteotomy for the Treatment of Pediatric Radial Neck Malunion and Anterior Radiocapitellar Dislocation: A Case Report.

Radial neck fractures are common injuries of the elbow in the pediatric patient. Surgical intervention is recommended for significant angulation and displacement or mechanical blocks to motion. Radial neck malunion is a rare complication and may result in altered joint mechanics and, if severe, joint incongruency. Dislocation of the radial head has yet to be reported in this population after radial neck malunion. Treatment for radial neck malunions with dislocation varies and can include radial head excision or radial neck osteotomy. Outcomes after radial neck osteotomy is limited to case reports and small cases series. We present a case report of pediatric patient with radial neck malunion and anterior radiocapitellar dislocation treated with joint realignment via opening wedge osteotomy. To our knowledge, this is the first report of a pediatric case with radial head dislocation secondary to neck malunion and the first described report using this technique.

Clinical Results of Surgical Treatment for Comminuted Radial Head and Neck Fracture: Headless Compression Screws Versus Plate Fixation.

Background: We surgically treated comminuted radial head and neck fractures using headless compression screws, including multiple screws for the radial head and a single oblique screw for the radial neck. This study aimed to compare the clinical and radiological results for comminuted radial head and neck fractures between surgery using headless compression screws with a single oblique screw for the radial neck, our new procedure, and a plate system precontoured to the proximal radius. Methods: This retrospective study included 23 patients (11 and 12 in the screw and plate groups, respectively). The fractures were type 3 according to the Mason-Johnston classification modified by Broberg and Morrey. Clinical outcomes analyzed included the motion range of the elbow and forearm, Mayo Elbow Performance Score, and radiological assessments. In addition, postoperative complications were also investigated. The average follow-up was 18 months. Results: The bone union was achieved in all the patients, and there were no significant differences in clinical outcomes and radiological assessments except forearm supination (p = 0.02). Furthermore, additional surgical procedures were performed in one and five patients in the screw and plate groups, respectively (p = 0.16). Posterior nerve palsy was observed in two patients in the plate group. Complications were observed in one and six patients in the screw and plate groups, respectively (p = 0.07). Conclusion: Both surgical procedures achieved good clinical and radiological outcomes with bone and ligament injury repair. The screw group had a greater range of forearm supination than the plate group.

Pediatric Radial Neck Fractures: A Systematic Review Regarding the Influence of Fracture Treatment on Elbow Function.

Background: This review aims to identify what angulation may be accepted for the conservative treatment of pediatric radial neck fractures and how the range of motion (ROM) at follow-up is influenced by the type of fracture treatment. Patients and Methods: A PRISMA-guided systematic search was performed for studies that reported on fracture angulation, treatment details, and ROM on a minimum of five children with radial neck fractures that were followed for at least one year. Data on fracture classification, treatment, and ROM were analyzed. Results: In total, 52 studies (2420 children) were included. Sufficient patient data could be extracted from 26 publications (551 children), of which 352 children had at least one year of follow-up. ROM following the closed reduction (CR) of fractures with <30 degrees angulation was impaired in only one case. In fractures angulated over 60 degrees, K-wire fixation (Kw) resulted in a significantly better ROM than intramedullary fixation (CIMP; Kw 9.7% impaired vs. CIMP 32.6% impaired, p = 0.01). In more than 50% of cases that required open reduction (OR), a loss of motion occurred. Conclusions: CR is effective in fractures angulated up to 30 degrees. There may be an advantage of Kw compared to CIMP fixation in fractures angulated over 60 degrees. OR should only be attempted if CR and CRIF have failed.