Pediatric Pediatric Radial Neck Fracture
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
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
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