Percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation of angulated radial neck fractures in
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ORIGINAL ARTICLE
Percutaneous k‑wire leverage reduction and retrograde transphyseal k‑wire fixation of angulated radial neck fractures in children Daniele Massetti1 · Mario Marinelli2 · Giulia Facco1 · Danya Falcioni2 · Nicola Giampaolini2 · Nicola Specchia1 · Antonio Pompilio Gigante1 Received: 11 December 2019 / Accepted: 10 March 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose To describe clinical and radiographic outcomes after surgical management of angulated radial neck fracture in children. Methods Twenty children (aged 2–11 years) with angulated radial neck fracture with more than 30° angulations (Judet type III and IV fractures) were retrospectively reviewed. All the enrolled patients were surgically treated with percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation. Clinical outcomes were evaluated using Tibone and Stoltz score and the Mayo Elbow Performance Score (MEPS). Radiographic outcomes were evaluated with Métaizeau score. Complications were also evaluated. Results At a mean follow-up of 20 months, no patients showed axial deformity of the upper limb or instability of the elbow. The mean value of the MEPS was 99.2, and excellent clinical results were achieved in 14 patients (73.7%) at Tibone and Stoltz score. The final X-rays showed fracture healing in all patients; furthermore, 75% of patients showed excellent reduction at Métaizeau score. No patient developed complication. There were no iatrogenic nerve injuries or pin infections. Conclusions The results demonstrate that percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation of angulated radial neck fracture treatment is a simple, effective, rapid and inexpensive procedure. Level of evidence IV (case series and systematic review of level IV studies). Keywords Angulated radial neck fracture · Pediatric elbow injury · Pediatric trauma · S.E.R.I. technique
Introduction The radial head is the second ossification center to appear at 3 years of age, and it fuses with the radial neck at 15 years of age (± 1 year for influence of gender) [1]. Isolated radial neck fractures represent 6.5% of elbow fractures in children [2] with a peak age of 9–10 years old [1]. Angulated radial neck fracture in children is usually caused by indirect injury associated with a fall with the elbow in the straight position * Daniele Massetti [email protected] 1
Clinical Orthopaedics, Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Via Conca, Torrette, 60100 Ancona, Italy
Clinic of Adult and Paediatric Orthopaedics, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy
2
and the forearm supinated. Approximately 50% of patients with angulated radial neck fracture are complicated with other injuries of the elbow, such as elbow dislocation, proximal ulnar fracture, coronoid process fracture and humeral supracondylar fracture [3]. Most fractures are undisplaced (Judet type I) or minimal
