Research Paper
E-ISSN NO : 2455-295X | VOLUME : 3 | ISSUE : 8 | AUG 2017
MANAGEMENT OF RADIAL NECK FRACTURES IN CHILDREN AND ADOLESCENTS. A RETROSPECTIVE ANALYSIS OF SELECTED METHODS OF TREATMENT. SLAWOMIRKIEPURA, M.D, ABCDEF 1 | PROF. JULIAN DUTKA, PH.D., ADE 2 | MARIA WIECZOREK-GROHMAN,PH.D. D,F 3 1 PEDIATRIC
SURGERY DEPARTMENT OF SPECIALISTIC HOSPITAL ZEROMSKI IN KRAKOW, POLAND. (STUDY DESIGN A) (DATA COLLECTION B) (STATISTICAL ANALYSIS C) (DATA INTERPRETATION D) (MANUSCRIPT PREPARATION E) (LITERATURE SEARCH F). 2 ORTHOPEDIC AND TRAUMATOLOGY SURGERY DEPARTMENT OF SPECIALISTIC HOSPITAL ZEROMSKI IN KRAKOW, POLAND. (STUDY DESIGN A) (DATA INTERPRETATION D) (MANUSCRIPT PREPARATION E). 3 PEDIATRIC SURGERY DEPARTMENT OF SPECJALISTIC HOSPITAL ZEROMSKI IN KRAKOW, POLAND. (DATA INTERPRETATION D) (LITERATURE SEARCH F). ABSTRACT Objective: To compare outcome of different treatment methods according to fracture type in a retrospective study of results of treatment of radial neck fractures in children. Material and methods: In this retrospective analysis we present results of 17 children treated for radial neck fracture. There were 11 boys and 6 girls in the average age of 9.8 years (6.3 – 15). Follow up period amounted 6 – 48 months. Presence of growth plate and radio logically confirmed radial neck fracture type II – IV were including criteria for the study. Treatment results assessment was based on Mayo Elbow Score and radiological criteria of bone union. Results: In the analyzed material good and very good results were achieved in group II and III , fair results were achieved in group IV. There were no failures of treatment. Conclusion: Review of clinical and radiological results of these uncommon fractures indicate that very good and good results can be achieved in conservative and closed surgical methods. In open surgery results are inferior. Keywords:
Background
IV
Fracture of the radial head comprises 5-10% of elbow fractures in children and 1% of all pediatric fractures. It may result in deformity, limitation of movement and functional impairment of the elbow joint. Radial neck fractures are more common than radial head fractures in this age. Other injuries like medial epicondyle avulsion fracture, lateral condyle fracture, medial collateral ligament tear and olecranon fracture may be present. Fracture occurs due to fall on outstretched upper limb with elbow in valgus or in elbow dislocation when radial head impacts against the capitellum. Judet classification of radial neck fracture is based on angular or percentage displacement of the neck against the radial shaft (table 1).
Treatment of radial neck fractures in children depends on age of the patient, angular displacement and contact of fragments. In most of the cases fracture is either undisplaced or with minimal displacement (type I, II Judet). In this case conservative treatment using above elbow cast is recommended.
Table 1. Classification Of Cervical Fractures Of The Radius Depending On Lateral And Angular Displacement According To Judet. Degre e
Lateral translocation (%)
Angular translocation (°)
I
0 – 10
0 – 30
II
11 – 50
31 - 60
III
51 - 90
61 - 90
> 90
> 90
In fractures with angular displacement exceeding 30 deg ( type III, IV Judet) surgical treatment is necessary using percutaneous K wire fixation, intramedullary fixation using titanium elastin nails ( Metaiseau technique) and open reduction and internal fixation if closed methods are unsuccessful. In segmental fractures or concomitant elbow fractures open intervention is also indicated. Open reduction, however, may result in complications reported in the literature including growth arrest with subsequent axial deformity of the forearm, avascular necrosis of the radial head due to blood supply interruption and ectopic ossification with limitation of elbow mobility. In our study we present retrospective analysis of clinical and radiological results of treatment of radial neck fractures in children using various methods of stabilization including Metaizeau method with intramedullary fixation of fracture with K wire later modified be elastic titanium
INTERNATIONAL EDUCATIONAL SCIENTIFIC RESEARCH JOURNAL
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