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

• DOI: 10.1007/s00402-021-03917-w
• Publication Date: 2021-05-11T12:03:44Z
• Authors: Markus Dietzel; Simon Scherer; Michael Esser; Hans-Joachim Kirs...; Jörg Fuchs; Justus Lieber
• Keywords: Male; Trauma Surgery; 610; Bone Nails; Fracture Fixation, Intramedullary; 3. Good health; Radius; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Elbow; Humans; Female; Child; Radius Fractures; Female [MeSH] ; Trauma Surgery ; Humans [MeSH] ; Treatment Outcome [MeSH] ; ESIN ; Retrospective Studies [MeSH] ; Radius Fractures/surgery [MeSH] ; Pediatric trauma ; Proximal radius fracture ; Fracture Fixation, Intramedullary/adverse effects [MeSH] ; Radius/surgery [MeSH] ; Male [MeSH] ; Pseudarthrosis ; Elbow [MeSH] ; Child [MeSH] ; Radial neck fracture ; Bone Nails [MeSH] ; Elastic stable intramedullary nailing; Retrospective Studies

Abstract 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.