Pediatric Pediatric Radial Neck Fracture

synonyms:

Pediatric Radial Neck Fracture ICD-9

Pediatric Radial Neck Fracture Etiology / Epidemiology / Natural History

• most common in children 9-12 y/o
• MOI=valgus stress with compression on Radial neck

Pediatric Radial Neck Fracture Anatomy

Pediatric Radial Neck Fracture Clinical Evaluation

• Pain and swelling in the lateral elbow.
• Document NV exam before and after any treatment.

Pediatric Radial Neck Fracture Xray / Diagnositc Tests

• A/P. lateral and oblique xrays of the elbow and A/P and lateral views of the forearm.

Pediatric Radial Neck Fracture Classification / Treatment

• angulation >30 degrees or translation greater than 3mm requires reduction
• Closed reduction #1: distraction with varus stress on elbow followed by positioning of radius to apply pressure over Radial head forcing it back into position
• Closed reduction #2: apply Esmarch to forearm producing uniform compression with elongation which reduces fracture
• Closed reduction #3: apply laterally directed force on Radial shaft while elbow is stressed into varus.  Radial head is positioned with C-arm in the plane of maximum angulation and pressure is applied to proximal fragment.  (Neher CG, J Pediatr Orthop 2003;23:626-28)
• Closed reduction #4:  make percutaneous incision to insertion a small elevator over Radial shaft to pull the shaft laterally while Radial head is pushed medially.  +/- percutaneous pin to  manipulate proximal fragment.
• Metaizeau Technique: insert a contoured flexible nail from the distal radius into the proximal fragment.  Rotating the nail reduces the fracture and stabilizes the fracture reduction. (Metaizeau JP, J Pediatr Orthop 1993;13:355-360), (Schmittenbecher PP, JPO 2005;25:45).
• Open reduction: only used if closed techniques fail.  Lateral approach.  Fixation with temporary k-wires(removed at 3-4wks) or small screws

Pediatric Radial Neck Fracture Associated Injuries / Differential Diagnosis

• 50% have associated fractures
• Monteggia fracture

Pediatric Radial Neck Fracture Complications

• loss of forearm rotation
• up to 45 degrees angulation can be accepted
• >45 degrees angulation or any displacement can lead to loss of forearm rotation as it causes abutment of Radial head on the Pediatric Radial notch (Wedge JH, JBJS 64B;256:1982)

Pediatric Radial Neck Fracture Follow-up Care

• poor results associated with children >10y/o, delayed treatment, following open redution, severe injury
• loss of forearm rotation can occur even with anatomic reduction
• Long arm cast  for 3 wks

Pediatric Radial Neck Fracture Review References

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