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Objective:To explore the diagnosis and treatment of humeral medial epicondyle fracture combined with radial neck fracture in children and adolescents.Methods:The clinical data were retro-spectively analyzed of the 12 pediatric patients with fractures of the humeral medial epicondyle plus the radial neck who had been admitted from February 2015 to August 2021 to Department of Pediatric Orthopedics, The Second Hospital of Fuzhou. There were 6 males and 6 females, with an age of (11.1 ± 2.5) years. According to the Papavasiliou classification, the humeral medial epicondyle fractures were type Ⅱ in 7 cases, type Ⅲ in 2 cases and type Ⅳ in 3 cases; according to the Judet classification, the radial neck fractures were type Ⅰ in 3 cases, type Ⅱ in 4 cases and type Ⅲ in 5 cases. Two Judet-Ⅰ radial neck fractures were missed by X-ray exam-ination but diagnosed by CT examination. Of the humeral medial epicondylar fractures, 9 were treated by open reduction and hollow screwing and 3 by closed reduction and Kirschner wiring. Of the radial neck fractures, 8 were treated by closed reduction and elastic intramedullary nailing and 4 conservatively. Fracture healing was followed up by postoperative radiographs. At the last follow-up, the carrying angles were measured, Kim Elbow Function Score (KEPS) was used to evaluate the functional recovery of the injured limb, and related complications were recorded.Results:All the 12 patients were followed up for (40.0±25.6) months. Fractures headed after (6.3±1.2) weeks. At the last follow-up, the carrying angle was 15.5°±2.6° on the injured side and 14.7°±2.0° on the healthy side, showing no significant difference ( P>0.05); KEPS was (96.3±5.3) points on the injured side and (98.8±2.3) points on the healthy side, showing no significant difference either ( P>0.05). No incision infection, bone nonunion, elbow valgus, joint stiffness or other complications were found; the postoperative elbow stability recovered well. Conclusions:As the fracture of the humeral medial epicondyle combined with the radial neck fracture is a special type of injury of straightened elbow during valgus stress in children and adolescents, it is likely to be missed in diagnosis. The goal of treatment is good functional recovery by restoring the articular match and elbow stability.
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Objective:To evaluate the ultrasonography-guided percutaneous leverage reduction in the treatment of pediatric radial neck fractures.Methods:From May 2016 to May 2018, 42 patients with Judet Ⅲ or Ⅳ radial neck fracture were treated at Department of Pediatric Orthopedics, The Second Hospital of Fuzhou. They were 15 boys and 27 girls, aged from 3 to 12 years. All of them were treated by percutaneous leverage reduction and Métaizeau technique. The operative procedures were guided by ultrasonography in 20 cases and by C-arm fluoroscopy in 22 cases. Postoperative evaluation was based on Métaizeau imaging criteria, Tibone and Stoltz functional criteria; complications such as radial nerve injury were recorded.Results:There were no statistically significant differences between the ultrasonography-guided group and the fluoroscopy-guided group in preoperative general data, showing comparability ( P>0.05). There were no significant differences between the 2 groups in terms of Métaizeau imaging, Tibone or Stoltz functional scores ( P>0.05). The frequency of fluoroscopy was (2.7±0.6) times for the ultrasonography group and (14.6±3.4) times for the fluoroscopy group while the operation time averaged (25.8±5.9) min for the former and (38.1±9.2) min for the latter, showing significant differences ( P<0.05). No postoperative complications were observed in the ultrasonography group while 4 cases of radial nerve injury in the fluoroscopy group, also showing significant difference between the 2 groups ( P< 0.05). Conclusion:Ultrasonography-guided percutaneous leverage reduction is a suitable surgical treatment of radial neck fracture in children, because it is simple, effective and safe.
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Introduction: Radial head and neck fractures are one of the commonly encountered traumatic injuries. Commonlyproposed management includes radial head prosthesis implant or open reduction and internal fixation dependingon type of injury. Radial head measurements are very valuable in reconstruction of radial head. Appropriateanatomy of radial head will help in preventing postoperative stiffness and enable good rehabilitation.Aims and objectives: To estimate and compare radial head parameters of proximal end of right and left radii.Materials and Methods: Radial head measurements -Height of radial head in medial (MH) and lateral (LH) side,Antero posterior diameter (APD) and transverse diameters (TD) of radial head, Thickness of ventral (TVC), lateral(TLC) and dorsal (TDC) curves and depth of articular facet (D) were measured with the help of digital caliper.Statistical analysis was done using SPSS software. Difference in sides was measured using independent sampleT test (p value < 0.05 considered significant).Results: Mean values of Radial head measurements were APD:19.81mm, TD:18.925mm, MH:9.795mm,LH:7.735mm,TVC:5.05,TDC:3.695,TLC:3.64,D:1.735.There was difference in values of TLC between right and leftsides.Conclusion: Mean values of radial head measurements were comparable with previous studies. Side differenceshould be considered while implanting prosthesis on affected side.
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<p><b>PURPOSE</b>The aim of this study is to discuss the results of different intramedullary devices used in the management of paediatric radial neck fractures and to suggest methods to avoid the pitfalls of the technique.</p><p><b>METHODS</b>Thirty patients with isolated Judet III and IV fractures were included in this prospective study. Judet I and II fractures and radial neck fractures associated with other injuries were excluded. The final results were graded using the Metaizeau functional scoring system and Oxford Elbow Score.</p><p><b>RESULTS</b>The functional result was good to excellent in 24 of 30 cases (80%). The mean Oxford Elbow Score was 44.32. The mean follow-up was 40.11 months. The complications seen were radiocapitellar joint penetration - 6 cases at mean 4.87 weeks, redisplacement - 6, radial epiphyseal sclerosis - 5, and heterotopic ossification - 1 case.</p><p><b>CONCLUSION</b>Intramedullary K wires may result in radiocapitellar joint penetration. Titanium Elastic Nail System should not be used as purely fixation devices as they may not prevent redisplacement. Regular follow-up until at least 6 weeks is essential. Patients who have a Judet IV fracture and need open reduction should be given a guarded prognosis. The paper highlights the pitfalls of the technique and makes recommendations regarding the type of implant, follow-up and patient counselling in Judet IV fractures.</p>
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Objective To analyze the influence of radial neck fracture on the upper limb function in older children,and to evaluate the curative effect of plate fixation in the treatment of Salter-Harris Ⅱ type of radial neck fracture.Methods The clinical data of 16 older children with radial neck fractures who treated by T plate internal fixation were retrospectively analyzed.16 cases were closed fractures,merging radial nerve injury in 1 case,3 cases of distal humerus fractures,1 case with rib fractures,fractures were Salter-Harris Ⅱ type,adopt steel plate internal fixa tion.Results 1 6 patients were followed up for 9-1 8 months.X-ray healing time was 6-9 weekson average 7.6 weeks.No malunion and no healing,no case of epiphyseal injuries.1 patient appeared steel block forearm supination.Postoperative patients with forearm pronation were greater than 90° supination were greater than 60 °.No radial nerve injury.Evaluation results were good.Conclusion Clinical treatment effect of open reduction and plate internal fixation in the treatment of older children with Salter-Harris Ⅱ type of radial neck fracture is satisfactory.Surgical treatment not only can enhance the fracture stability,but also can do the elbow joint function exercise to prevent dysfunction much earlier.
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Radial head and neck fractures are the most frequently seen elbow fractures. The usual cause of this injury is a fall onto an outstretched hand with a partly flexed elbow. We report here an unusual case of bilateral non displaced radial neck fractures in a patient who presented with complaints of pain in both elbows following a simple fall. This case highlights the need for a high index of suspicion in the diagnosis of multiple injuries, no matter how `trivial` the mechanism of injury.
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[Objective]To investigate the effect and complications of treating radial neck fractures in children with elastic stable intramedullary nail(ESIN).[Method]A retrospective study was applied in 35 children(5~13 years) with displaced radial neck fractures,that were corrected with ESIN in our hospital from 2005 to 2008.[Result]All cases were successfully followed up,with an average time of 7.5 months.Ninteen cases were evaluated as excellent,6 cases were good,the excellent and good rate was 68%.Avascular necrosis was found in 9 cases,including 4 cases of radial head bulk formation,1 case showed ossification and delayed union was proved in 2 cases.[Conclusion]Treating the radial neck fracture with ESIN is a simple and minimally invasive method,the overall effect is good while the complications are limited.
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In children, the radial neck fractures are treated in various ways, including long arm cast without closed reduction, long arm cast following C/R by Patterson's or Pesudo's method, open reduction with or without K-wire fixation. We treated 25 children with radial neck fracture who visited DaeDong General Hospital from March 1992 to February 1995, and followed up average 17.4 months (from 13 months to 27 months). The results of clinical analysis are as follows: l. Age distribution was from 3 to 15 years old, and the mean was 9.4 years old. 2. Twelve cases showing less than 30degrees initial angulation were treated with long arm cast without reduction, and all of them resulted in excellent result. 3. Patterson s C/R method was useful in cases with angulation between 30degrees ~45degrees. In patients with more than 45degreesangulation, Pesudo method was more effective. 4. 3 cases with 90 angulation were treated by open reduction and internal fixation, and all of them showed unexpected excellent results. 5. Premature epiphyseal closure was present in 2 cases but both of them revealed good functional result.
Subject(s)
Adolescent , Child , Humans , Age Distribution , Arm , Hospitals, General , NeckABSTRACT
This paper was prepared to determine the effects of degree of initial angulation and the method of treatment toward the end results, and also to report cases of twenty-one children with a radial neck lowed up more than 12 months. The results are as follows: 1. An average follow up period was 34 months, and were ranged from 12 months to 70 months. 2. Displacement patterns of fracture were angulation in 5 cases, partial translocation in 11cases, and total displacement in 5 cases, and translocated fracture was most frequent. According to the degree of angulation, in 10 cases angulation was minor(below 30 degrees), in 8 cases moderate(30–60 degrees), and in 3 cases severe (above 60 degrees). 3. One case was treated by simple cast immobilization, 9 cases were treated by gentle closed reduction, 3 cases were by percutaneus pin reduction with K-wire, 7 cases were by open reduction and K-wires fixation, and 1 case was by closed reduction and incorporating cast immobilization. 4. The results of 20 cases were excellent in range of motion without specific complication. Without considering about the method of treatment, when angulation was severe, more time was required for recovery(Wilcoxon 2-simple test P < 0.02). When the degree of angulation was less than 60 degree, the functional recovery was faster with closed reduction than with open reduction, but with the angulation more 60 degree, there was no significant difference(Spearman correlation coefficient=0.599, P value < 0.05). In conclusion, the severity of initial displacement and the method of treatment were considered to be factors that could affect the recovery time.
Subject(s)
Child , Humans , Follow-Up Studies , Immobilization , Methods , Neck , Range of Motion, ArticularABSTRACT
Complete fractures of radial neck or proximal radial epiphysis with 90° displacement are very rare, and only several cases were reported in the literatures. We have experienced 2 cases of radial neck fracture with 90° posterior displacement and one case with anterior displacement. All of them were treated operatively. We followed up these 3 cases more than 15 months and report the results with review of literatures.