Surgical Management of Pediatric Radial Neck Fractures

• DOI: 10.2106/jbjs.l.01130
• Publication Date: 2013-10-16T19:32:12Z
• Authors: Ryan M. Zimmerman; Leslie A. Kalish; M. Timothy Hresko; Peter M. Waters; Donald S. Bae
• Keywords: Percutaneous pinning

Background: Management of pediatric radial neck fractures is controversial regarding acceptable alignment, variable reduction techniques, and suboptimal outcomes. The purpose this study was to assess the characteristics, management, results in a surgical cohort, efforts identify prognostic factors offer treatment suggestions. It hypothesized that less invasive maneuvers would precede open worse correlate with fracture severity, reduction, presence associated injuries. Methods: Retrospective analysis 151 children whom had been surgically treated from 2001 2011 performed. mean age (and standard deviation) duration follow-up were 8.4 ± 2.9 years 13.3 20.0 months, respectively; 40% patients male. A successful clinical result defined as elbow flexion ≥120°, contracture <20°, forearm rotation ≥90° ≥45° supination pronation, no complications. Results: An isolated occurred 54% children. angulation displacement improved 43° 19° 37% 35%, respectively, before 13° 7° 0.9% 4% after (p < 0.001). Twenty-two procedural combinations used treat these patients, 67% reductions not preceded by percutaneous or closed attempts. Among 131 adequate follow-up, 31% an unsuccessful outcome. ten more (odds ratio [OR] = 5.85, p 0.001), time surgery two days (OR 4.73, 0.02), greater 1.25 per 10%, 0.001) independent predictors Increased severity poor results, although concomitant injuries not. predicted manipulation will fail for half angulated ≥36°, displaced ≥65% require reduction. frequency outcomes 50% 76% displacement. Conclusions: There continues be great variation approach Suboptimal series, older than years, who increased underwent Less methods should whenever possible. Level Evidence: Therapeutic IV. See Instructions Authors complete description levels evidence.