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Stepwise Percutaneous Leverage Technique to Avoid Posterior Interosseous Nerve Injury in Pediatric Radial Neck
Wan-Sun Choi1, Kyeong-Jin Han, Doo-Hyung Lee
1*Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea; and †Department of Anatomy, Graduate School, Ajou University School of Medicine, Suwon, Korea.
Insights
This study introduces a stepwise percutaneous leverage technique for pediatric radial neck fractures, effectively avoiding posterior interosseous nerve (PIN) injury and achieving excellent clinical outcomes.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Trauma surgery
Background:
- Radial neck fractures are common in children.
- Traditional surgical approaches carry a risk of posterior interosseous nerve (PIN) injury.
- Minimally invasive techniques are sought to improve outcomes.
Purpose of the Study:
- To present a novel stepwise percutaneous leverage technique for treating pediatric radial neck fractures.
- To evaluate the efficacy and safety of this technique, specifically focusing on preventing PIN injury.
- To identify factors influencing treatment outcomes.
Main Methods:
- Retrospective case series of 34 pediatric patients with radial neck fractures.
- Utilized a stepwise percutaneous leverage technique involving Steinmann pins for reduction and fixation.
- Radiographic assessment using Métaizeau classification and clinical outcomes via Mayo Elbow Performance Score (MEPS).
Main Results:
- No instances of posterior interosseous nerve (PIN) palsy were reported.
- Radiographic results were excellent in 23 cases and good in 9.
- The average Mayo Elbow Performance Score (MEPS) was 97.6, indicating high functional recovery.
Conclusions:
- The stepwise percutaneous leverage technique is a safe and effective method for treating pediatric radial neck fractures.
- This technique minimizes the risk of neurovascular complications, particularly PIN injury.
- Postoperative Métaizeau classification emerged as a significant predictor of treatment success.
Objectives:
To introduce a stepwise percutaneous leverage technique to avoid posterior interosseous nerve (PIN) injury in pediatric patients with radial neck fractures and to evaluate the clinical outcome and the predisposing factors affecting the outcome.
Design:
Retrospective case series study.
Setting:
University level 1 trauma center.
Patients:
Thirty-four children with a radial neck fracture, who were treated using a stepwise percutaneous leverage technique, were included in the study.
Intervention:
The radial head fragment was reduced by pulling the first Steinmann pin proximally as a lever. Then, the kinked soft tissue was released by removal of the Steinmann pin with buttressing the radial head by the operator's thumb. The second Steinmann pin was inserted into relaxed soft tissue for fixation of the radial head.
Main Outcome Measurements:
We used the Métaizeau classification as a radiologic result and Mayo Elbow Performance Score (MEPS) as a clinical outcome. Regression analysis was performed to identify the predisposing factors affecting the outcome.
Results:
There was no occurrence of PIN palsy. According to the Métaizeau classification, 23 cases were classified as excellent, 9 as good, 1 as fair, and 1 as poor. The average MEPS was 97.6 points. Based on the regression analysis, only the postoperative Métaizeau classification was confirmed as a risk factor of a relatively poor outcome.
Conclusions:
The stepwise percutaneous leverage technique can be considered a good option in the treatment of pediatric radial neck fractures, because it ensures excellent results by avoiding injury to soft tissues including the PIN.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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