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Close Reduction Technique for Severely Displaced Radial Neck Fractures in Children
Maulin M Shah1, Gaurav Gupta1, Qaisur Rabbi1,2
1Paediatric Orthopaedic Surgeon, OrthoKids Clinic, 7th Floor, Golden Icon, Opp. Medilink Hospital, Satellite, Ahmedabad, 380015 India.
Insights
This study shows close reduction effectively treats severely displaced paediatric radial neck fractures (Judet Type IVa and IVb). All patients achieved anatomical reduction and full elbow motion, avoiding surgery.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Radial neck fractures are a common pediatric elbow injury, accounting for 5-10% of cases.
- Judet classification categorizes these fractures into five types (I-IVb).
- Severely displaced fractures (Type III, IVa, IVb) typically require reduction, but current methods lack uniformity in achieving complete reduction.
Purpose of the Study:
- To present a case series on the experience with close reduction for severely displaced pediatric radial neck fractures (Judet Type IVa and IVb).
- To evaluate the efficacy of close reduction in achieving complete anatomical reduction and functional outcomes.
Main Methods:
- Ten consecutive children (average age 8.59 years) with severely displaced radial neck fractures (Judet Type IVa/IVb) underwent close reduction.
- All reductions were performed within 48 hours of injury.
- One patient had an associated undisplaced lateral condyle fracture; two with elbow dislocations were excluded.
Main Results:
- Complete anatomical reduction was achieved in all ten patients using the described close reduction technique.
- No patients required surgical fixation.
- At one-year follow-up, all patients demonstrated a near-full range of elbow and forearm motion with complete union and no avascular necrosis.
Conclusions:
- Close reduction is a viable and effective technique for managing severely displaced pediatric radial neck fractures (Judet Type IVa and IVb).
- This method provides an alternative to surgical intervention, achieving excellent anatomical and functional outcomes.
Introduction:
Radial neck fractures account for 5-10% of paediatric elbow trauma. Radial neck fractures have been classified by Judet into five types (I-IVb). There is a global agreement to reduce radial neck fractures with angulation more than 30° (Type III, IVa and IVb). Various maneuvers have been described but none of them uniformly achieved complete reduction in severely displaced radial neck fractures (Type IVa and Type IVb Judet). In this case series, we are presenting our experience with close reduction of ten severely displaced paediatric radial neck fractures to achieve complete anatomical reduction.
Methods:
We attempted close reduction in ten consecutive children with average age of 8.59 ± 1.68 years (range, 6-12 years) who presented with severely displaced radial neck fracture (Type IVa and IVb Judet). There were five girls. All patients had close injuries and presented to us within 24-48 h. One of the patients had associated undisplaced lateral condyle fracture. We have excluded two patients with associated elbow dislocation. Close reduction was performed within 48 h of initial injury.
Results:
We were able to obtain complete anatomical reduction in all of our patients with this technique. None of the patients required fixation of fracture. At 1 year of follow-up, (12 ± 2.07 months, range 9-16 months) all patients demonstrated almost full range of elbow and forearm motion. Final radiographs revealed complete union without any evidence of avascular necrosis.
Conclusion:
This technique offers an option of close reduction for the most severely displaced radial neck fractures, which were otherwise being treated by surgical intervention.
Electronic Supplementary Material:
The online version of this article (10.1007/s43465-020-00168-6) contains supplementary material, which is available to authorized users.
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