Radial neck fracture nonunion in children

Radial neck nonunion in children is a rare complication of a displaced radial neck fracture. The authors conducted a retrospective review of nine cases of radial neck nonunion in an effort to identify risk factors for nonunion and to evaluate treatment options. Nine patients, average age 8.2 years, sustained displaced Salter-Harris type II fractures of the radial neck, with average angulation of 83 degrees and average displacement of 83%, and elbow dislocation or additional fracture in eight of nine patients. Initial treatment with open reduction achieved anatomical alignment of the fracture fragments in seven of the nine patients. Initial reduction was lost and radial neck nonunion developed in all patients. The nonunion was treated with observation, radial head and neck excision, or open reduction and internal fixation with bone graft, depending on the level of pain, deformity, and functional deficit. Healing of the nonunion did not necessarily lead to improvement of clinical symptoms. Severity of initial fracture displacement and inadequate fixation technique contributed to radial neck nonunion. Treatment of the nonunion should depend on the patient's pain, deformity, and functional restriction.