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Prognostic factors for intramedullary nailing in radial neck fracture in children
Julien Hemmer1, Adèle Happiette1, Florence Muller1
1Chirurgie Orthopédique et Traumatologique Pédiatrique, Hôpital d'enfants, CHU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
Insights
Avoid open reduction for pediatric radial neck fractures, as it leads to poor outcomes. Intramedullary nailing is preferred for treating these fractures in children.
Area of Science:
- Pediatric Orthopedics
- Pediatric Trauma Surgery
- Pediatric Bone Fractures
Background:
- Radial neck fractures are rare but potentially serious pediatric injuries.
- Treatment for these fractures remains controversial, with limited research on prognostic factors.
- Intramedullary nailing is considered the gold standard for treating radial neck fractures.
Purpose of the Study:
- To evaluate the functional outcomes of radial neck fractures treated with intramedullary nailing.
- To identify factors influencing the results of radial neck fracture treatment.
- To compare the outcomes of closed reduction versus open reduction in radial neck fractures.
Main Methods:
- Retrospective analysis of 56 pediatric patients with radial neck fractures (2005-2015).
- Treatment involved Métaizeau intramedullary nailing, with open reduction reserved for failures.
- Inclusion criteria: Jeffery type 1 fracture, open growth plate, complete file, and ≥1 year follow-up.
Main Results:
- Open reduction was significantly associated with poor functional outcomes (p<0.01).
- Factors like age, initial tilt, associated lesions, immobilization, and residual tilt did not significantly affect outcomes.
- Percutaneous leverage had no impact on results (p=1).
Conclusions:
- Open reduction should be avoided in pediatric radial neck fractures.
- Further prospective studies are needed to investigate age-related remodeling potential.
Introduction:
Radial fracture accounts for 1% of fractures in children. It is potentially serious, and treatment is controversial. Several studies assessed prognostic factors, only one of which used exclusive intramedullary nailing, despite this being the gold standard.
Hypothesis:
Open surgery provides poor functional results in radial neck fracture.
Material And Method:
All patients undergoing reduction and internal fixation of radial neck fracture between 2005 and 2015 were analysed. Inclusion criteria comprised Jeffery type 1 fracture with open growth plate, complete file, and ≥1 year's follow-up. Treatment systematically comprised Métaizeau intramedullary nailing, with crossover to open reduction only in case of failure. Good results were defined as full range of motion and pain-free elbow.
Results:
Fifty-six patients were included: 33 girls, 23 boys; mean age, 9 years. On the Judet classification modified by Métaizeau, 4 fractures were grade 2, 29 grade 3, 15 grade 4A and 8 grade 4B. Closed reduction was performed in 48 cases, including 8 with the help of percutaneous leverage effect. Eight required a surgical approach. Twenty-three showed postoperative reduction defect. At a mean 74 months' follow-up, at a mean age of 15 years, 37 patients had reached full skeletal maturity. Sixteen had poor results. Open reduction was associated with poor outcome (p<0.01). Age, initial epiphyseal tilt, associated lesions, immobilisation time, time to nail removal and residual tilt after reduction did not significantly affect outcome (p-values>0.05). Percutaneous leverage effect had no impact on the quality of results (p=1).
Discussion:
Open reduction is to be avoided in radial neck fracture. A prospective study is needed to assess remodelling potential according to age.
Level Of Evidence:
IV, retrospective study.
