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Excellent functional outcomes and low complication rate following open reduction for severe pediatric radial neck
Francesco Puglia1, Luca Tanel2, Daniele Priano1
1U.O.C. Ortopedia e Traumatologia Pediatrica, ASST Gaetano Pini/CTO, Piazza Cardinal Ferrari 1, Milan 20122, Italy.
Insights
Open reduction for pediatric radial neck fractures after failed closed reduction offers excellent outcomes. Complications, not surgical delay, significantly impact functional results in these rare injuries.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Trauma surgery
Background:
- Pediatric radial neck fractures are rare and challenging to manage.
- Open reduction is often reserved for complex cases, potentially leading to higher complication rates.
- This study evaluates outcomes of open reduction after failed closed reduction in pediatric patients.
Purpose of the Study:
- To assess functional outcomes and complication rates in pediatric patients with radial neck fractures treated with open reduction.
- To identify risk factors and predictors of outcomes and complications in this cohort.
Main Methods:
- Retrospective cohort study of 53 pediatric patients with Judet 4 radial neck fractures.
- Surgical open reduction was performed after unsuccessful closed reduction.
- Functional outcomes (Oxford Elbow Score) and complications were analyzed using statistical models.
Main Results:
- Excellent functional outcomes were observed, with a mean Oxford Elbow Score of 96.
- Complications occurred in 13.5% of patients, including heterotopic ossification and nerve injury.
- Complications were the primary predictor of poorer functional outcomes, unlike surgical delay.
Conclusions:
- Open reduction after failed closed reduction provides excellent functional results for pediatric radial neck fractures.
- Complications, particularly heterotopic ossifications, are key determinants of poor outcomes.
- Surgical delay and patient age did not significantly influence outcomes or complication rates.
Background:
Pediatric radial neck fractures, though rare, pose significant management challenges with several treatment options. Open reduction is typically used for more complex cases, where greater fracture severity may contribute to higher complication rates and poorer outcomes. This study aims to evaluate functional outcomes, complications, and risk factors in a large cohort of pediatric patients treated with open reduction, performed after unsuccessful closed reduction.
Methods:
A retrospective cohort study was conducted on 53 pediatric patients (mean age 8 years) with radial neck fractures (Judet 4) treated surgically with open reduction, performed after unsuccessful closed reduction, at a single institution between March 2014 and October 2024. Data on surgical delay, complications, and functional outcomes (Oxford Elbow Score) were collected. Statistical analyses included correlation tests, t-tests, and multivariate regression models to assess predictors of outcomes and complications.
Results:
The mean Oxford Elbow Score was 96, indicating excellent functional outcomes. Complications occurred in 13.5% of patients, including heterotopic ossification (9.6%), posterior interosseous nerve injury (1.9%), and avascular necrosis (1.9%). Surgical delay was significantly longer in patients with complications (p = 0.038). Multivariate analysis revealed that complications were the most significant predictor of poorer functional outcomes (β = -17.12, p < 0.001), while the surgical delay did not significantly impact outcomes or complication rates.
Conclusion:
Open reduction, performed after unsuccessful closed reduction, for pediatric severe radial neck fractures yields excellent functional outcomes with a low complication rate. Complications, such as heterotopic ossifications, are the primary determinant of poor outcomes, whereas surgical delay and age do not significantly affect results.
Level Of Evidence:
Level III - Retrospective cohort study.
