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Open Reduction of Displaced Radial Neck Fractures in Children by Internal Fixation Techniques: Comparison of
Yao Liu1, Lun-Qing Zhu1, Fu-Yong Zhang1
1Department of Orthopaedics, Children's Hospital of Soochow University, Suzhou, 215000 Jiangsu Province China.
Insights
For pediatric radial neck fractures requiring open reduction, K-wire (KW) fixation offers comparable outcomes to elastic stable intramedullary nailing (ESIN) fixation but at a lower cost and with fewer complications.
Area of Science:
- Pediatric Orthopedics
- Surgical Techniques
- Fracture Management
Background:
- Paediatric radial neck fractures often require open reduction for severely displaced cases.
- Elastic Stable Intramedullary Nailing (ESIN) and K-wire (KW) fixation are surgical options.
Purpose of the Study:
- To compare the efficacy and outcomes of ESIN versus KW fixation in pediatric patients undergoing open reduction for radial neck fractures.
Main Methods:
- A comparative study included 24 pediatric patients (mean age 8.5 years) with Judet type III or IV radial neck fractures.
- Patients were divided into two groups: 10 underwent percutaneous KW fixation (Group A) and 14 underwent ESIN fixation (Group B).
- Outcomes assessed included surgical time, fracture reduction quality, cost, healing time, clinical function (Steele and Graham classification), and complications.
Main Results:
- No significant differences were found in age, sex, fracture type, or reduction quality between groups.
- Group A (KW fixation) had significantly lower costs.
- Fracture healing occurred in 23/24 patients; functional outcomes were excellent/good in 80% of Group A and 78.6% of Group B.
- Group B (ESIN) experienced two cases of nail shifting and joint protrusion, with one nonunion.
Conclusions:
- Both KW and ESIN fixation provide good clinical outcomes for pediatric radial neck fractures.
- KW fixation is associated with lower costs and reduced iatrogenic complications, including easier implant removal without secondary surgery.
Background:
Although most paediatric radial neck fractures can be treated with closed reduction, some severely displaced fractures require open reduction. The purpose of this study is to compare the effects of ESIN and KW fixation in open reduction of radial neck fracture in children.
Methods:
Twenty-four patients with mean age of 8.5 years were included. Four of the patients had a Judet type III fracture and 20 had a Judet type IV fracture. Ten patients who underwent percutaneous KW fixation were assigned to group A, while 14 patients who underwent ESIN fixation were assigned to group B. Variables of interest included age, sex, fracture type, associated lesions, surgical time, fracture reduction, cost, follow-up, healing time, X-rays, clinical outcomes, and complications.
Results:
There were no significant between-group differences in sex, age, additional injuries, fracture type, and quality of reduction. Costs were significantly lower in Group A. Fracture healing was achieved in 23 of 24 patients (10/10 in group A and 13/14 in group B). In a postoperative elbow function assessment based on the Steele and Graham classification, 80% of patients in group A had a score of excellent or good, compared to 78.6% of patients in group B. Two cases of nail shifting and joint protrusion were observed in group B, one of which also presented with nonunion during follow-up.
Conclusions:
Both KW and ESIN may achieve good clinical outcomes, but KW is associated with lower costs, easier implant removal (without the need for a secondary surgery), and lower iatrogenic complications.
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