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Treatment decision, method of osteosynthesis, and outcome in radial neck fractures in children: a multicenter study
Peter P Schmittenbecher1, Bernd Haevernick, Arnold Herold
1Department of Pediatric Surgery, St. Hedwig's Hospital, Clinical Center Barmherzige Brüder, Regensburg, Germany. schmittenbecher@barmherzige-regensburg.de
Insights
Closed elastic-stable intramedullary nailing (ESIN) for pediatric radial neck fractures shows satisfactory results. Minimizing open interventions appears crucial for improving outcomes in these childhood bone injuries.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Radial neck fractures are common pediatric injuries.
- Elastic-stable intramedullary nailing (ESIN) is a technique used for fracture fixation.
Purpose of the Study:
- To evaluate the efficacy and acceptance of closed ESIN for pediatric radial neck fractures.
- To assess the outcomes and complication rates associated with ESIN treatment.
Main Methods:
- A prospective multicenter case collection study.
- Analysis of 66 pediatric radial neck fracture cases from 12 departments over 2 years.
- Classification of fractures by severity (Judet grades 1-4) and treatment approach (reduction vs. no reduction, open vs. closed fixation).
Main Results:
- 54.5% of fractures (Judet grades 1-2) treated without reduction had good to excellent results.
- 74% of grade 3-4 fractures achieved good to excellent results after closed or open reduction.
- Elastic-stable intramedullary nailing (ESIN) was used in 23 reduced fractures, with 78% achieving good to excellent outcomes.
- Seven children experienced significant pronation/supination restrictions, with three cases linked to open reduction.
Conclusions:
- Closed ESIN is widely accepted and yields satisfactory results for pediatric radial neck fractures.
- Minimizing open interventions may be key to improving functional outcomes and reducing complications.
- ESIN represents a viable and effective treatment option for specific pediatric radial neck fractures.
Abstract:
To determine whether closed elastic-stable intramedullary nailing (ESIN) of radial neck fractures in children is accepted as standard procedure with satisfactory results, a prospective multicenter case collection study was conducted. Sixty-six cases from 12 departments were analyzed during 2 years. Thirty-six fractures of Judet 1 or 2 grade (54.5%) were treated without reduction; all of these fractures showed good to excellent results. Thirty fractures of grade 3 or 4 needed a closed (25 [37.9%]) or open reduction (5 [7.6%]), and 74% of them had good to excellent results. Osteosynthesis was carried out in 26 of the reduced fractures (23 ESIN, 3 Kirschner wire fixation). Using ESIN, 78% of the results were good to excellent. Seven children developed significant restrictions of pronation/supination, including three of the five open reduced fractures. ESIN has found wide acceptance, and the results are satisfactory. Restricted use of open interventions may be the key to improving results.
